Healthspeak Summer 2015 by North Coast Primary Health Network

ISSUE 10 summer 2015

HealthSpeak

A publication of North Coast NSW Medicare Local

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HealthPathways The right care at the right place at the right time page 5

Co-location success

Meet a genetic counsellor

Compassion fatigue

Memories of Flanders

Editor Janet Grist Head Office Suite 6 85 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Vahid Saberi Email: enquiries@ncml.org.au

We at North Coast Medicare Local would like to wish all of you a relaxing and fun festive

season. Take care on the roads and don’t drink and drive or drink and swim! And for any tips on health and wellbeing over the summer, why not check out Healthy North Coast’s Facebook page. It’s full of interesting information on many health topics with something for everyone. A big thank you goes out to

all of HealthSpeak’s talented contributors. A vast array of talent and expertise comes together to produce each issue. I look forward to sharing more stories with you in 2015, reflecting the health care landscape of the NSW North Coast. Best wishes, Janet

Hastings Macleay 53 Lord Street Port Macquarie 2444 Ph: 6583 3600 Cnr Forth and Yaelwood Streets Kempsey 2440 Southern Region Manager: Donna Burns Email: dburns@ncml.org.au Mid North Coast Suite 2, Level 1, 92 Harbour Drive Coffs Harbour 2450 Ph: 6651 5774 Southern Region Manager: Donna Burns Email: dburns@ncml.org.au

Walking the tightrope of integration CEO Vahid Saberi

Northern Rivers Tarmons House 20 Dalley Street Lismore 2480 Ph: 6622 4453 Northern Region Manager: Chris Clark Email: cclark@ncml.org.au Tweed Valley Unit 4, 8 Corporation Circuit Tweed Heads South 2486 Ph: (07) 5523 5501 Northern Region Manager: Chris Clark Email: cclark@ncml.org.au

Contacts Editor: Janet Grist Ph: 6622 4453 Email: media@ncml.org.au Clinical Editor: Andrew Binns Email: abinns@gmc.net.au Design and illustrations: Dougal Binns – Graphiti Design Studio Email: dougal@gdstudio.com.au Display and classified advertising at attractive rates

HealthSpeak is published four times a year by North Coast NSW Medicare Local Ltd. Articles appearing in HealthSpeak do not necessarily reflect the views of the NCML. The NCML accepts no responsibility for the accuracy of any information, advertisements, or opinions contained in this magazine. Readers should rely on their own enquiries and independent professional opinions when making any decisions in relation to their own interests, rights and obligations. ©Copyright 2015 North Coast NSW Medicare Local Ltd Magazine designed by Graphiti Design Studio Printed by Quality Plus Printers of Ballina

Integration, world-wide, is upheld as a most urgent need in health care delivery. It is argued that ‘integrated care’ is the most significant strategy that could make a singular difference to patient outcomes and health care system efficiency and efficacy. Literature, including grey literature, contains many examples and case studies of effective integration. There is much written about the elements, characteristics, principles and pathway tools to integration. So why aren’t we all doing it? Why is this task so difficult? Broadly speaking, there are many impediments and barriers to integration. Among the obvious ones in Australia are the current delineation of responsibility between State and Commonwealth (one responsible for acute care and the other for primary health care); health care funding instruments and arrangements; performance measures and reporting requirements. All of which create walls and silos within the system. Another contributor to fragmented health care is the science of medicine itself which treats the human body as bits – heart and kidney and so forth – rather than a cohesive whole. Following on this is the manner in which we design health care and hospitals,

in body part departments. Additionally, there are social and human factors. Notably, resistance to change and being comfortable with the familiar and the status quo. There is also the influence of outdated and obsolete mindsets such as “if it ain’t broke don’t fix it” which is probably relevant to the horse and buggy technology (the time when the phrase found its way into our psyche) but is counter to the principles of continuous improvement and adaptive change. Despite all these challenges, and no doubt you can think of others, good progress is being made. On the North Coast we have done a lot in commencing and advancing the integration journey. Reflecting on our experience on the North Coast of NSW, one thing stands out for me. The bedrock for a culture of collaboration, which is integral to coordinated care, is trust, goodwill and solidarity. Trust and goodwill provide the rich soil in which the seed of collaboration and partnership germinates and grows. When I think of collaboration and coordination, I think of walking a tightrope! It is inevitable when organisations come together to collaborate that there will be differences and possible conflicts. This should not surprise us. Like

someone learning to walk the tightrope, it is inevitable that there are occasional falls. However, where there is camaraderie and trust - a safety net - the partnership is protected against injury and harm. Without the safety net as soon as things get hard or go wrong, frustrations and impatience sets in, the work comes to a halt and even the relationships are damaged. It is hard to achieve lasting transformational change without the safety net and building the safety net takes time, energy and effort. The invitation to apply for the establishment of Primary Health Networks (PHN) has now been released. We are pleased that the North Coast of NSW has its own PHN - one of the few regions nationally to remain unchanged. While there are some differences in the operation of Medicare Locals (MLs) and PHNs, the foundation of the work of both MLs and PHNs has much in common. We are excited about this opportunity and are confident that if successful in our bid to become a PHN, we can go on to build on the work of the past two and half years; minimise lost time and momentum and restart costs; and further strengthen our local collaborations and partnerships that are the bedrock of any lasting transformative change.

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HealthSpeak

A publication of North Coast Medicare Local

summer 2015

Two-speed Indigenous health continues The latest Australian Institute of Health and Welfare (AIHW) report Mortality and life expectancy of Indigenous Australians 2008 to 2012 shows that estimated life expectancy at birth for males was 69.1 years and for females 73.7 years. These may sound like good figures – if we were living in the previous century. The sad fact is that they are 10.6 years and 9.5 years lower respectively than the life expectancy of non-Indigenous males and females. While the report by the AIHW – the federal government’s main data collection agency on health trends - did show small improvements in Indigenous life expectancy, the gains had done little to close the longevity gap because non-Indigenous life expectancy improved much more markedly in the decade to 2012. In some diseases, including cancer, the gap was actually widening: non-Indigenous Australians were found to be living longer, with Indigenous mortality rates rising. One encouraging trend was a 57 per cent decline in the Indigenous infant mortality rate between 2001 and 2012 (with a 26 per cent decline in the non-Indigenous rate). Over that period, there was a significant decline in the mortality rate difference between Indigenous and non-Indigenous infants, with the gap, which still continues, more than halving. These large declines in infant mortality in recent decades are likely to be the result of large reductions in deaths from sudden unexpected death in infancy (which includes SIDS), and deaths from conditions originating in the perinatal period (AIHW 2013). However the reason for the adult longevity gap is chronic disease, with four groups accounting for more than twothirds of the problem: circulatory disease - 24 per cent of the gap, endocrine, metabolic and

nutritional disorders - 21 per cent, cancer 12 per cent and respiratory diseases 12 per cent. Between 2008 and 2012, cancer accounted for 20 per cent of all Indigenous deaths, with lung cancer, the most common cancer death, accounting for 5.1 per cent of deaths in Indig-

had been done by governments to improve the living conditions of indigenous Australians. (SMH 10/09/14) “Diabetes is a disease that is entirely preventable, but we don’t yet have, as a nation, a sufficient commitment to recognising that where you live

Indigenous diabetes rates are three times the rest of the population

enous males and 4.7 per cent in females. Lung cancer rates rose slightly in the Indigenous population from 2001 to 2012. A second report released by the Australian Bureau of Statistics showed one in 10 Indigenous people had diabetes, three times the rate of the rest of the population. It is well known that chronic diseases are largely lifestylebased, which relates very much to social determinants - where people live, inadequate housing, poverty, poor education, lack of job prospects, access to health services, transport issues, high incarceration rates, and so on. Primary health care services are important but they are hamstrung by providers’ inability to adequately address these social determinants, this being a socioeconomic and political issue. Martin Laverty, the chief executive of the Royal Flying Doctor Service and the founder of the Social Determinants of Health Alliance, said too little

HealthSpeak A publication of North Coast Medicare Local

summer 2015

and your geography, influences your risk of chronic illness,” he said. He highlighted the broadly supported Senate report in March 2013 that recommended five ways in which the government must act to address the social factors that cause ill-health, yet that report was “still sitting on a shelf awaiting a government response”. Senate Report’s List of Recommendations: 1 The committee recommends that the Government adopt the WHO Report and commit to addressing the social determinants of health relevant to the Australian context. 2 The committee recommends that the government adopt administrative practices that ensure consideration of the social determinants of health in all relevant policy development activities,

Opinion Andrew Binns

particularly in relation to education, employment, housing, family and social security policy. 3 The committee recommends that the government place responsibility for addressing social determinants of health within one agency, with a mandate to address issues across portfolios. 4 The committee recommends that the NHMRC give greater emphasis in its grant allocation priorities to research on public health and social determinants research. 5 The committee recommends that annual progress reports to parliament be a key requirement of the body tasked with responsibility for addressing the social determinants of health. For now we can only hope the Closing the Gap initiatives for general practice and Aboriginal Community Controlled Health Services continue to be supported and that the disadvantaged, including Indigenous people, are exempt from the Government’s co-payment proposal for GP visits should this pass the Senate. Additionally, measures like smoking cessation programs need to be stepped up, not wound down as appears to be the current fashion (see Crikey 25/08/14 ). In fact, the Australian government recently announced funding cuts of $130 million over five years to the Tackling Indigenous Smoking program, which amounts to more than one-third of the program’s annual funding. If such an important initiative runs out of breath, so will the many people whose future wellbeing depends on being encouraged and supported to adopt healthier lifestyles.

Tweed RACFs in wound care pilot A number of Tweed RACFs have taken part in the only pilot in Australia of The Wound Management Residential Aged Care Education Pilot Project (REPP). The pilot was jointly funded by the North Coast Medicare Local (NCML) and the Wound Management Innovation Cooperative Research Centre. The project involved local wound expert, Gerard Robards. He provided training and coaching in evidence-based wound management practice and prevention to staff of three RACFs in the Tweed Valley over three months. Participating in the project were BUPA Banora Point, BUPA Pottsville and the McKenzie Aged Care Group, Heritage Lodge Murwillumbah. A major component of data collected was staff surveys and resident skin integrity checks which staff were trained to administer. Project sponsorship was provided by Professor Helen

Staff at Heritage Lodge in Murwillumbah undergoing Doppler training.

Edwards, from QUT. During the project, nominated site champions at regular stakeholder meetings shared their successes from making policy and procedure changes, implementing a moisturising protocol and recording skin tears before and after this change, taking photos of residents’ skin prior to

transfer to hospital and purchasing a Doppler machine to allow better vascular assessment of residents. The results and feedback supported the findings that educational intervention increased staff confidence levels in wound management. Staff felt that the training resulted in improved

Ongoing community engagement

resident outcomes and 85% agreed or strongly agreed that they would recommend the education to others. The Skin Integrity Survey results indicate that wound prevalence is a significant concern, with over 60% of residents surveyed having a wound and over 80% showing evidence of a previous skin tear. Over 40% of staff reported regularly managing venous leg ulcers, arterial leg ulcers, mixed venous/arterial ulcers and diabetic foot ulcers. Increases in staff confidence levels for managing these wound types was reported. Despite the short project timeframe, a significant reduction in resident wound prevalence was observed, and encouraging results were shown relating to changes in practice and increased adoption of evidence-based wound management and prevention. Significant results were found in the use of specialty bed or chair pressure relieving devices; use of risk assessment and implementing a resident turning regimen. The active involvement of the Medicare Local project officer enabled changes which led to better communication between local hospitals and the RACFs, thereby increasing the confidence of the RACF staff in what could be achieved through stronger collaboration with the Medicare Local. This collaboration proved to be a key success factor for the pilot and the project leaders thank the residents, staff managers and champions of the three sites for their enthusiastic participation.

Coraki residents and NCML staff got together again in October to talk further about health.

After providing free first aid training for 32 residents of Coraki, a small town near Lismore, earlier this year, North Coast Medicare Local (NCML) met with the community again in October to talk with residents and learn more about the town’s health needs. Coraki is one of 15 small towns across the North Coast that NCML has identified as

having limited or no existing medical services, especially after hours. Residents of these towns are receiving free first aid training through the Medicare Local’s First Aid in Small Towns program. The October meeting was part of ongoing conversations with Coraki townsfolk to identify gaps in health services and look at possible solutions to fill the gaps.

At the October meeting a variety of concerns were identified including the need for a full-time GP in the town, transport solutions to get residents to and from hospitals, and a request for more education on a healthy diet and lifestyle for members of the Aboriginal community. NCML staff will continue to work with Coraki residents on a range of issues.

HealthSpeak

Correction In the Spring edition of HealthSpeak there was an error on page 13. Sonia Davis was described as a clinical psychologist, whereas she is a general psychologist. HealthSpeak apologises for any concern this error may have caused.

A publication of North Coast Medicare Local

summer 2015

HealthPathways expands across North Coast

Some participants at the Lismore training day. From left: Kerrie Keyte, HealthPathways NCML Program Officer; Tracy Baker Acting Regional General Manager, Mid North Coast, NCML; Juanita Gibson, Manager HealthPathways Australia and NZ; Sharyn White, Manager Strategic Development and Program Design NCML; Ian Anderson, Director, Streamliners NZ; Chris Clark, Regional Northern General Manager NCML; Dan Ewald, Clinical Advisor NCML; Fiona Ryan, HealthPathways Program Officer NCML; Lynne Weir, General Manager, Lismore Base Hospital; Graham McGeoch, Chief Clinical Editor, HealthPathways NZ.

Northern NSW Local Health District and North Coast NSW Medicare Local are collaborating to extend HealthPathways to reach the entire North Coast. HealthPathways are published on an online information password-protected portal to be used at the point of care for GPs but are also available to specialists, nurses and allied health providers on how to assess, manage and refer in a timely manner in the local context of available services. It is underpinned by evidence-based practice. The website is not designed for use by patients or community members, however there will be resources available on the portal that GPs and health professionals can provide to patients. Collaborating to develop clinical pathways that are driven by clinicians as part of a patient management process will promote fast and timely care of patients in primary care settings as well as more effective referral of patients to secondary care clinicians. Each HealthPathway starts with a particular health problem and defines a pathway for management that reflects evidence-based best practice in the context of locally available resources and facilities. The HealthPathways program provides an opportunity to link general practitioners, hospital clinicians, allied health professionals and private medical specialists into the reform process. Representatives from all health sectors are able to be involved in the development of relevant HealthPathways, with their services identified in the published product. This bottom up health system reform has proven to be very effective for patient care, efficiency, quality and clinician engagement. NCML’s CEO Vahid Saberi said HealthPathways was an exciting joint project which would improve patient care, effi-

ciency, quality and clinician engagement. “It is another great tool we can use to better

integrate local health services” he said. “The process of developing a locally-defined HealthPathway may also lead to new solutions as clinicians work across the hospitalcommunity interface,” Mr Saberi said. Mr Crawford said that HealthPathways was an exciting opportunity for the NNSWLHD to continue its collaborative work with NCML to improve links between health professionals. The Mid and North Coast HealthPathways website is already live and available to local clinicians. Information about Northern NSW services will be added over the next few months. On 22 and 23 October, more than 70 Medicare Local and Local Health District clinicians and staff met in Lismore to learn about the program which has already been successfully introduced on the Mid North Coast. The HealthPathways website is at: http:// mancproject.healthpathways.org.au/ Please email Tracy Baker on: tbaker@ncml.org. au to obtain the website password.

Life-changing insulin pump for teen A North Coast Medicare Local Aboriginal Health program has changed a teenage girl’s life through the purchase of an insulin pump to help her control her diabetes. Leteasha Ruttley is a 15-year-old Aboriginal teenager living in the Port Macquarie area with Type One diabetes. A few months back, NCML’s Care Coordination and Supplementary Services (CCSS) Program Coordinator Deb Cushing became aware through Port Macquarie Community Health staff that Leteasha was struggling to control her insulin levels and that her diabetes was getting her down and having a negative impact on her overall health. Leteasha has now been handling the insulin pump for three months and is managing it well. Before getting the pump, Leteasha’s diabetes was difficult to control with regular ‘hypos’ – where blood glucose levels drop too low. These hypoglycaemic episodes cause symptoms such as weakness, shaking, dizziness and lack of concentration. Deb said that Leteasha’s hypos had now reduced, her blood glucose levels were within normal parameters and her overall health had improved. Leteasha said she benefits by not having to give herself an insulin needle at lunchtime and is attending school more.

HealthSpeak A publication of North Coast Medicare Local

summer 2015

Leteasha Ruttley with her certificate confirming she is an Ambassador for diabetes.

Having the insulin pump has resulted in fewer sick days and hospital visits. The insulin pump has enabled her to attend her first camp, and she now an ambassador for diabetes. The pump has also allowed Leteasha the confidence to stay overnight at her friend’s house which previously was challenging due to her uncontrolled blood sugars. Leteash’s Mum Jannine is happy that her daughter is now able to manage her diabetes. “The pump has given her a level of independence and confidence in the selfmanagement of her disease. She has so

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Tweed carers group wins rap comp

The Domino Effect, with winners Nathaneal Paulson (back row, far left), Indi Lipscombe (back row, second from left), Mandu Currie (back row, third from left), Maxi Wood (front row, far right) and program organiser Maria Breene (back row, far right).

The Tweed Heads’ youth carers group The Domino Effect won NCML’s Rap and Poetry Slam 2014. The competition was part of NCML’s PITCH program – Practical Ideas to Change Health Care – which aims to channel creative energies and nurture new ideas about

local health issues. The competition theme was ‘Mental Health Matters’, in keeping with International Youth Day 2014. Youth on the North Coast were invited to submit a two-minute Rap or Poetry audio track that addressed the issue of mental health. The winners were announced following

voting by the Healthy North Coast online community at a community party hosted at headspace in Lismore on October 30. The Halloween themed event included food, live music and brought youth together from the Lismore region. The Domino Effect claimed both first and second prize with their rap tracks ‘Mind Over Matter 1’ by Indi Lipscombe (age 12) and Nathaneal Paulson (age 13), and ‘Mind Over Matter 2’ by Maxi Wood (age 12) and Mandu Currie (age 14). Third place went to Maya Duel Grigg (age 15) for her poem ‘Due Date’, which addressed student anxiety and the pressure for high achievement. The Domino Effect is a youth carers group that empowers young people aged 12 to 24 years to manage their emotional, physical and mental wellbeing. “It has been rewarding to engage with local youth in a creative way on an important issue like mental health,” NCML Manager Gavin Dart said. “Thank you to all the young people who made the effort to enter, and congratulations to all the winners. The Domino Effect really impressed us with their commitment to improving the health of young people.”

Quality Awards celebrate achievements North Coast Medicare Local’s very first Quality Awards ceremony was held at Opal Cove Resort in Coffs Harbour on Thursday evening November 6 and it was a fun night celebrating the many achievements of NCML since it opened in April 2012. The evening’s guest speaker was Mr Chris Shipway, Director, Primary Care & Chronic Services, Agency for Clinical Innovation, who helped present the awards and entered into the light-hearted spirit of the night. A total of 28 programs/services were nominated for the Quality Awards. NCML’s Chief Executive Vahid Saberi said he could not have been more proud of the number and the quality of the submissions put forward. The scope of the work of NCML was well represented and the judging panels no doubt had a difficult job in making their final decisions. The teams recognised on the night were: 6

The Alliance for Vulnerable Communities team accepting their award. From left: Vickie Williams, Philippa Visser, Megan Lawrance, NNSWLHD Chief Executive Chris Crawford and Vicki McGowan.

Category 1 – Healthy Minds – Wendy Pannach, Megan Lawrance and the Mental Health Team Category 2 – Healthy North Coast – Gavin Dart and the HNC Team Category 3 – Walking Together – Emma Walke and

the Aboriginal Health Team Category 4 – Alliance for Vulnerable Communities – CEO Office, Sharyn White and Team Health Pathways was highly commended by the NCML Board – Tracy Baker, Sharyn White and the System and Service Integration Team HealthSpeak

from page 5 much more control of her diabetes with the insulin pump. Without NCML’s support we would still be struggling to control her diabetes.” The CCSS program aims to improve the health and well being of Aboriginal and Torres Strait Islander people with certain chronic health conditions: diabetes, cancer, renal disease, respiratory disease, or cardiac disease. A written referral and GP management Plan (GPMP) is required through the patient’s GP. For more information about NCML’s Aboriginal Health Programs, contact: Tweed Valley: 07 5523 5500 Lismore: 02 6622 4453 Coffs Harbour: 02 6659 1800 Kempsey: 02 6562 1055 Port Macquarie: 02 6583 3600

A publication of North Coast Medicare Local

summer 2015

Co-location pilot gets thumbs up Reports from the 11 general practices taking part in the Co-location pilot (where nurse practitioners are co-located within general practices, working alongside GPs) have been positive, with both doctors and patients pleased with the trial arrangements. The pilot is being run in partnership with both Northern NSW and the Mid North Coast Local Health Districts. The program involves co-locating clinicians from each local health district into general practices in their region. HealthSpeak visited Dunoon Medical Centre to speak to Anne-Maree Cheffins, a colocated chronic disease nurse practitioner employed by the Northern NSW Local Health District. Anne-Maree is enjoying working at the three general practices she is co-locating with. She told HealthSpeak that patients are happy with the specialised care and longer appointments she provides. Her patients are mainly those with chronic respiratory and cardiovascular conditions. “Having an hour long initial appointment enables discussion to occur regarding pharmaceutical administration, early recognition of symptom deterioration, escalation of management strategies and risk

Benzo use and Alzheimer’s

From left: Tracey Smith, practice manager; Jessica Lowe, administration, Anne-Maree Cheffins, nurse practitioner and Dr Nathan Kesteven at Dunoon Medical Centre.

factor modification to maintain a healthier lifestyle. “Often patients have been given information about their condition but they are not sure about how best to manage their health and many need help with the use of spacers and puffers, for example.” Anne-Maree also gave an example of a patient she’d helped that day. “I saw an elderly lady and asked how she was coping at home. She said she was getting unsteady on her feet and was having trouble walking around the shopping mall. She was using a shopping trolley as an aid. “She also told me her husband wasn’t showering because he was afraid of having a fall. I was able to give that feedback

to the general practice staff who organised for a practice nurse to go out and assess her home and recommend devices to be installed to make the home safer and easier to get around. That meant a lot to her.” Dunoon Medical Centre’s Dr Nathan Kesteven is also positive about working with AnneMaree and appreciates the skills she brings to her role as chronic disease nurse practitioner. The Co-location Pilot Project started in May and Southern Cross University has been engaged to evaluate the program which will run until March next year. For information, contact NCML’s Health Reform Project Officer Bernadette Carter on 6622 4453.

Those who’ve taken benzodiazepines for three months or more face a 43 to 51% increased risk of Alzheimer’s disease, a new study has found. The case-controlled study, written up in a BMJ editorial, used ‘rigorous methods’ from cases recorded on the database of the Quebec public drug plan. Researchers matched a total of 1796 people over 66 years of age with a diagnosis of Alzheimer’s with 7184 controls. The authors wrote that using benzodiazepines for less than three months did not increase the risk of Alzheimer’s. However for those who used the drug for three to six months carried an increased risk from 32% to 84%. In addition, for those patients taking long-acting benzodiazepines the increased risk was higher (70%). BMJ 2014; online 10 September

Healthy North Coast Practitioner Events PRACTITIONER EVENTS

Healthy North Coast is the central hub for all health professionals to access information on learning and development events on the North Coast. You can search for a particular event, or register and upload your own event for free. Visit www.healthynorthcoast.org.au/practitioner-events Healthy North Coast....It’s all about health

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summer 2015

Practice Nurse Home Visits Trial A trial of Practice Nurse Home Visits has been funded by the NSW Agency of Clinical Innovation and is underway in the Medicare Local footprint. The trial is assessing and evaluating a new way for general practices to provide practice nurse home visits to their patients. It aims to enhance service provision and improve the continuity of care offered by the practice to patients who would unreasonably suffer by having to attend the practice location. Eight practices have been recruited to the trial. It has been shown that

emergency department use can be reduced in situations where home visits are available, particularly for the elderly or for those with chronic conditions affecting mobility. However, the number of home visits being offered by GPs is declining, creating a gap in service. The trial allows practice nurses from participating practices to provide an outreach service to address this gap, with the expectation that it will lead to increased patient satisfaction and improved outcomes. This project is being independently evaluated by researchers from the Southern

Cane toads: a healthy surprise Researchers have found that cane toad poison kills off prostate cancer cells while sparing healthy cells. Dr Harendra Parekh from the University of Queensland said a student had discovered Australia’s toad to be similar to the Asiatic toad which has been used in Chinese medicine for thousands of years. “We have what we believe is a selectively toxic agent which can kill tumour cells but spare healthy cells,” he said. In China, medicine made from toad poison is called chan su and is used to treat heart failure, sore throats, skin conditions and other ailments. During her studies, PhD student Dr Jing Jing was able to show that the poison from cane toads was very effective at killing cancer cells, and in particular prostate cancer cells, Dr Parekh said.

Cross University until March 2015. The following example illustrates one way in which the service has been used.

A frail, elderly lady with atrial fibrillation and difficulty coping living alone, had a fall and phoned her general practice. She had a history of multiple presentations to the hospital emergency department over the past year for similar events. The general practice, which is participating in this project, was able to respond by sending out a practice nurse to conduct a home visit. The nurse performed a physical assessment, treated grazes and reassured the patient - preventing the need for the lady to call an ambulance and potentially another ED presentation.

For further information please contact Fiona O’Meara, Program Officer NCML in the Mid North Coast area on 6659 1800 or Bernadette Carter Program Officer Northern NSW on 6622 4453. But while the drug has been used for a long time in Asia it can be dangerous in its raw form, and Dr Parekh and his team had been trying to make the drug more soluble. “Once we determine that the toxicity has been sustained, even after increasing solubility, the next stage will involve packaging it in innovative drug delivery systems, sent to cancer tissue,” he said. The team at the Queensland University’s Pharmacy Australia Centre of Excellence has received a grant from the Hong Kong Polytechnic University and a Chinese research institute. The researchers hope to have the initial screenings and studies carried out on the venom within 12-18 months. Cane toads were deliberately introduced to Queensland in 1935 but multiplied quickly and became a pest.

Practice nurses Jenny Stamel and Harriet St Leon outside Urunga Medical Centre

New ACI website The Agency for Clinical Innovation (ACI) has launched a new website www.aci.health.nsw.gov.au ACI Chief Executive, Dr Nigel Lyons, explained that the ACI works with clinicians, consumers and managers to design and promote better healthcare for NSW. “We conducted stakeholder research and user testing to better understand our online audience. This provided valuable feedback that has helped us improve the structure and design of the ACI website,” Dr Lyons said. A key feature of the new website is the integration of external ACI websites, in particular the Australian Resource Centre for Healthcare Innovations (ARCHI) website which was showcased at

HealthSpeak

the Innovation Symposium as the Innovation Exchange. “The Innovation Exchange is the place to visit online to discover and share innovative projects and initiatives to improve health care and learn from the experiences of others,” said Dr Lyons. In addition to the Innovation Exchange, the new ACI website delivers: a landing page for each ACI Clinical Network, Taskforce and Institute resources in a simple, intuitive way. clear information about the services ACI a more responsive layout for mobiles and tablets Find out more - visit: www. aci.health.nsw.gov.au

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summer 2015

Jullums’ Open Day success The Aboriginal and Torres Strait Islander community really got behind the Open Day at Jullums - Aboriginal Medical Service in Lismore on November 17. The Open Day, hosted by Jullums – Lismore Aboriginal Medical Service (run by North Coast Medicare Local) and with community and cultural support from Rekindling the Spirit, included traditional dancers from Kadina High School, a barbecue lunch, traditional games for the whole family run by Solid Mob, face painting and music. Popular local rapper Luke Kapeen really wowed the crowd. Jullums’ staff also offered information on managing diabetes and free dental checks. Jullums’ GP Dr Andrew Binns paid tribute to practice manager Christine Wilson, whom he said made Jullums a great place to work. Christine thanked the community for making the Open

Our community is our medical practice

Staff pictured at the Open Day in November

Day such a vibrant and successful one. “Our community is our medical practice and it’s great to see so many people here today. Solid Mob gave us our tee shirts and they have been very supportive of Jullums. And we’re also very excited about the Northern Rivers Community Foundation’s generous grant

to set up a community information kiosk at Jullums – it will certainly get a great deal of use and be very helpful for us.” The Open Day came about through a Rekindling the Spirit/Jullums Consumer Advisory Group meeting. At this meeting the community made it clear that they wanted community members to visit Jullums and

meet the staff and practitioners to find out what Jullums offers and who works there. Jullums provides quality and comprehensive primary health care to Aboriginal and Torres Strait Islander people living in and around the Lismore region. Services are community driven, culturally appropriate and multidisciplinary. Jullums’ staff includes GPs, registrars, a psychiatrist, a consultant physician, a dietician, a diabetic educator, a podiatrist, an exercise physiologist and a counsellor. The medical service also runs, in conjunction with the NNSW LHD, renal, cardiac and respiratory clinics. Phone Jullums on 6621 4366.

Ballina gets new MRI Service North Coast Radiology Group (NCRG) is pleased to announce the installation of a new state-of-the-art Siemens Aera 1.5T Magnetic Resonance Imaging (MRI) unit at its Ballina branch. The MRI unit features a short wide bore & quieter exams meaning it can accommodate more types of patients as well as assist in increasing patient satisfaction. This MRI unit enables NCRG, with its accredited Radiologists and experienced team, to deliver the most comprehensive range of diagnostic imaging services in Ballina within the one location. Computed Tomography (CT) | Magnetic Resonance Imaging (MRI) | Ultrasound Mammography | Bone Densitometry (BMD) | General & Dental X-Ray

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summer 2015

For bookings and appointments: 02 6618 2900 93 Tamar Street, Ballina NSW 2478 www.northcoastradiology.com.au

More locally delivered services making a difference. We see you.

Mental health problems in children: what do they look like?

healthy minds

The World Health Organisation recognises that mental health affects everybody – the way we view ourselves and what is going on around us, and how we cope with the stresses of life. When children are mentally healthy, they are better equipped to meet life’s challenges, bounce back from setbacks, are able to form positive relationships with family and friends, and enjoy life. They are able to use positive coping skills to manage their feelings and deal with difficulties. A National Survey of Mental Health and Wellbeing in 2000 found that 14 percent of children and adolescents in Australia have mental health problems. However, of those, only

one in four receive professional help. GPs, school counsellors and paediatricians are the professionals most frequently used by children and young people with mental health problems. Of the 4,500 families surveyed, the most common mental health problems for young people were somatic complaints and delinquent behaviour, with 7% of children and adolescents in the clinical range. Attention problems and aggressive behaviour were reported by 5 to 6% of the families. Between 3% and 4% of parents reported their child had social problems, was withdrawn, depressed, anxious, and/or had thought problems. Problems to take notice of are when a child’s behaviour is unusual or different from children of a similar age, has changed gradually or quite suddenly. Problems with feelings include ongoing anxiety or worry, depression, phobias, obsessive behaviours and eating issues. Often children express their feelings through behaviours. Problem behaviours include aggression, bullying, noncompli-

ance and being cruel to animals. Research has shown that children and young people experiencing mental health problems can effectively be treated using brief psychosocial and psychological interventions. These interventions can include cognitive behavioural therapy, behaviour therapy, skills training, parent training and familybased interventions. The Healthy Minds program offers free psychological interventions for children and their families where the parents or carers have a Health Care Card or are experiencing severe financial distress. Children experiencing a broad range of behavioural and emotional problems can be referred to Healthy Minds including attachment disorders, sleep disorders, encopresis and enuresis, bereavement disorders, mutism (selective/elective) and sexual disorders. For more details contact the Healthy Minds team on 1300 137 237 or email: healthyminds@ncml. org.au

Briefs

Pomegranate interactions Consuming pomegranate as a food, juice or extract in herbal medicines can interfere with the body’s uptake of pharmaceutical drugs, a study has found. The finding underscores the complex relationship between pharmaceutical drugs and food, according to co-author Dr Fanfan Zhou, from the Faculty of Pharmacy at the University of Sydney. The study, published in the journal Pharmaceutical Biology, looks at how active components in pomegranate interfere with the delivery of drugs via solute carrier transporter proteins. These play a key role in helping substances or molecules such as hormones move across biological membranes and are known to play key roles in drug absorption and distribution, said Dr Zhou.

New Horizons: Focus on wellbeing The team at New Horizons has a common saying: ‘We’ll put your wellbeing at the centre of everything we do’. At the heart of that promise is the life-changing work the team does every day. Since opening their doors more than 33 years ago, New Horizons has grown to offer a vast and diverse range of support services across New South Wales and Victoria. On the far North Coast alone, their teams in Lismore and Tweed Heads provide thousands of hours of support each week to people who would like support to enhance their wellbeing. Community Engagement Manager, Mid and Far North Coasts, Rennay Miller said New Horizons recognised that each person has a different story, different needs and different goals. 10

New Horizons staff Corina Byrne and Kylie Wolfgramm from the Tweed Heads office.

“Our approach to support is also a little bit different. We look at the whole person, and all the domains of their life that influence their overall wellbeing. “We take the time to discover what wellbeing means for each

customer, create individual plans that identify their unique needs, and connect people with the most appropriate services and supports to achieve their goals,” she said. New Horizons customers can choose from a range of support options depending on which domains of wellbeing they’d like to enhance. From basic skills for daily living, physical health, employment and education, accommodation, and community and social participation, right through to cultural and spiritual wellbeing and other more specialised, supports. Whatever the situation, New Horizons brings vast experience – spanning aged care, disability, employment, health, housing, humanitarian, Indigenous, justice and mental health – to address clients’ HealthSpeak

needs and support them to achieve their goals. “Finding the right support can sometimes be a daunting experience for people, which is why we offer people different ways to connect with us,” Rennay added. “People can pick up the phone, flick us an email or drop in to see us face-to-face. Whichever option makes our customers comfortable, we make the process of developing a plan easy, and we do it together.” Find out more about how New Horizons can help enhance your wellbeing by visiting newhorizons. net.au or calling 02 9490 0000 to connect with your local office.

A publication of North Coast Medicare Local

summer 2015

Heart Failure Maintenance Service The importance of physical activity as part of a heart failure treatment plan is well recognised. In the 2011 Update to the National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand Guidelines for the prevention, detection and management of chronic heart failure in Australia, it remained a Grade A recommendation. “All patients be referred to a specifically designed physical activity program, if available,” (Krum et al. 2011). Such a program does exist in Lismore at Southern Cross University Health Clinic. Patients are assessed by an Accredited Exercise Physiologist (AEP) and an individualised exercise prescription is tailored to accommodate their functional status. After this initial assessment patients attend group exercise sessions, guided by student exercise physiologists who are supervised by an accredited exercise physiologist. There is no time limit to patient attendance as this is a maintenance program and the first 12 weeks are free. This program is supported by the

Northern NSW Local Health District Heart Failure Service and Critical Care Nurse Mary Tolhurst-Stuart said management of Heart Failure can be complex as a result of the patient’s multiple comorbid conditions, polypharmacy, dietary concerns, and psychosocial issues. “A multidisciplinary team approach incorporating a Specialist Cardiac Nurse can support the patient to remain well at home with education including incorporation of exercise and stress management into daily activities to reduce hospital admissions, reduce depression and improve quality of life. “The heart failure exercise maintenance program at the SCU Health Clinic provides excellent ongoing physical activity advice and support for patients who wish to be more mobile,” she said. Heart failure patients such as Allan, whose tolerance to walking had been declining due to hip pain, have benefited from the exercise support offered by this service. “By going to that exercise once a week I’m – it’s sort of topping me up. It gets me active again – even if it’s only for an hour it’s great,

From death comes new life and comfort Organ and tissue donation can bring comfort to donor family members in their loss of a loved one and enable something positive to come out of tragedy. These are the key findings of a study released by the Organ and Tissue Authority highlighting families’ experience of organ and tissue donation. “The Donor Family Study provides a valuable insight into the family experience of the donation process, from initial donation conversations through to follow-up support given to donor families,” the Assistant Minister for Health, Fiona Nash said. “Most donor families surveyed (81%) said organ and tissue donation provided an opportunity for something positive to come out of a tragedy. For 94% of donor family members, the donation process provided them with comfort in their loss of a loved one.” Other key motivating factors for families to agree to organ and tissue donation included the belief that their loved one would have wanted to help others and to enable someone else to live a better life. The Donor Family Study also found that most donor family members felt discussions about donation were handled sensitively and with compas-

From left: Mary Tolhurst-Stuart, Allan Griffiin and Neil Chapman, exercise physiologist

it gets me up and gets me interested in doing things again,” Allan said. Sessions run twice a week Tuesday and Thursday, excluding Monday 22nd December until Monday 5th January inclusive, as this service is closed for summer holiday. For more information contact 6626 9131.

Dr Steven Stylian – Haematologist and Medical Oncologist Byron Bay Specialist Centre, Suite 6, 130 Jonson St

Preparing the donor heart for transplantation

sion, and that they were given sufficient information to make an informed and enduring decision about organ and tissue donation. The Donor Family Study surveyed 186 people from 132 families who agreed to or declined a loved one becoming an organ or tissue donor in 2010 and 2011. This study will be conducted every two years from 2014 to ensure the views of donor families are well understood. The study can be viewed at: www.donatelife.gov.au

HealthSpeak A publication of North Coast Medicare Local

summer 2015

Dr Stylian wishes to announce that he has commenced practice at the Byron Bay address above. Over the years he has wanted to address the need for specialist care in peripheral regions. He has also remained grateful for his patients travelling to the Gold Coast to access care and now wishes to minimise the need for them to do this. Dr Stylian provides care for all aspects of haematology and medical oncology and specifically provides tertiary level care for complex disorders including leukaemia, all types of malignant conditions, apheresis and stem cell transplantation. Urgent cases will be prioritised and all patients will be bulk billed. Dr Stylian is happy to provide phone advice if needed and is now ready to accept GP referrals. Ph: (07) 5597 1305 Fax: (07) 5597 1205 Email: reception@gcho.com.au www.gcho.com.au

Improving CKD in Aboriginal patients Bugalwena General Practice is a multi-disciplinary practice located in South Tweed Heads run by North Coast Medicare Local (NCML). It provides bulk-billing services for the Aboriginal and Torres Strait Islander community and their immediate families. Wishing to improve the care of patients with Chronic Kidney Disease (CKD), Bugalwena set a goal to increase the identification of Aboriginal and Torres Strait Islander patients with potential CKD so that specific management plans and team care arrangements could be provided. NCML organised a CKD workshop for the team, and Graeme Turner, a CKD Nurse Practitioner from Northern NSW Local Health District, gave a presentation on how to improve management of CKD and how to undertake searches through the database. Bugalwena’s practice manager Jacqueline Moody said Graeme’s presentation was really worthwhile as it helped staff to focus on what small steps could be taken to make a difference. To achieve their objective, the team undertook the following steps: 1 They focused on improving their CKD register by cleaning data to ensure the information was correct. They also updated their processes to ensure it is kept up to date. 2 The practice manager used the Pen Clinical Audit Tool to create a list of patients on the database at risk of having CKD. 3 A notification was entered into the clinical software so that when a patient at risk of CKD saw their GP, the GP was reminded to code CKD correctly 4 A urinary albumin creatinine ratio (ACR) check was implemented as part of the Aboriginal and Torres 12

CKD Register 80 60 40

North Coast NSW Medicare Local – Bugalwena Practice MLQIP: North Coast NSW Medicare Local Average

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Graeme’s presentation was really worthwhile as it helped staff to focus on what small steps could be taken to make a difference StraiIslander health checks and GP Management Plans. This action increased the number of patients on the CKD register. 5 The practice manager sent lists of Bugalwena’s patients at risk of having CKD to pathology companies to see if they had had estimated glomerular filtration (eGFR) or urinary ACR tests done at other general practices. Relevant results were then downloaded into Bugalwena’s software. This also increased the number of patients on the CKD register, and saved time and money in preventing duplication of pathology tests.

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The graph above shows the increase in patients on the CKD register at Bugalwena General Practice over the five months of data submission. This project increased the number of Bugalwena patients on the CKD register from 17 patients in April 2014 to 77 in August 2014. Specific management plans and team care arrangements were implemented for 50 new patients. The Improvement Foundation’s Closing the Gap: Measure and Act project invites general practices around Australia to collect, submit and

SLEEP CLINIC AYS OPEN D

FREE consultation

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measure data on key indicators that could lead to better health outcomes for Aboriginal and Torres Strait Islander people. Find out more about IF’s Closing the Gap: Measure and Act initiative at: improve.org.au/ projects/ctg to find out more or register. This project was undertaken as part of the Australian Primary Care Collaboratives (APCC) Program’s Medicare Local Quality Improvement Partnership. The APCC Program is funded by the Department of Health and delivered by the Improvement Foundation.

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HealthSpeak

A publication of North Coast Medicare Local

summer 2015

Understanding health professions: About genetic counselling Genetic counselling is a relatively new profession. It involves a communication process which aims to help individuals, couples and families understand and adapt to the medical, psychological, familial and reproductive implications of the genetic contribution to specific health conditions. This process integrates the following: Interpretation of family and medical histories to assess the chance of disease occurrence or recurrence. Education about the natural history of the condition, inheritance pattern, testing, management, prevention, support resources and

research. Counselling to promote informed choices in view of risk assessment, family goals, ethical and religious values. Support to encourage the best possible adjustment to the disorder in an affected family member and/or to the risk of recurrence of that disorder Currently, Australian Society of Genetic Counsellors’ members comprise Certified Genetic Counsellors, Associate Genetic Counsellors, students and others with an association with or interest in the discipline of genetic counselling Genetic Counsellors are employed in an increasing variety

of specialist health services where they contribute their expertise within a team approach to patient care. Before attending a genetic counselling session, it may be helpful to find out as much information as you can about the medical history of both sides of your family as this is the type of information discussed at your appointment. This might include How you are related to each family member, including whether family members are adopted or half relatives any major health conditions affecting family members the age of onset of each condition

information on miscarriages the cause and age of death of family members (if relevant). Clinical genetics units and/ or services are administered by public and private health facilities and may function quite differently. Most clinical genetics services require a letter or phone call from a referring health professional. Written referrals are preferred because this facilitates continuity of care following the genetic consultation. To find a genetics counsellor near you, go to: https://www. hgsa.org.au/asgc/find-a-geneticcounsellor Information from: Australasian Society of Genetic Counsellors website: https://www.hgsa.org.au/asgc

Profile Lorraine Hodgson, genetic counsellor Lorraine told HealthSpeak that ever since high school she’s wanted to learn more about science. “It wasn’t until 20 years after I left school that I had an opportunity to go to university and look closer at what type of science interested me the most so that I could plan out a new career pathway. I found I was naturally gravitating towards the biomolecular subjects and human genetics was to me the most fascinating.” Lorraine completed a Bachelor of Science and was accepted into a program to complete a Master of Science in Genetic Counselling. A people person, Lorraine knew the lab was not the right place for her, so she set her sights on becoming a genetic counsellor. “For me, this was a perfect marriage of keeping up with genetics technology and working with people to help them understand some of the complexities of this technology and how they may choose

to use it,” she explained. “I say to many of my clients that just because the technology and testing may be available, does not mean that it is in their best interests to utilise it.” For Lorraine, the most rewarding part of her job is the opportunity to help people better understand themselves as they move confidently through their decision-making process about what genetic information can offer them and whether to undertake genetic testing or not. “Most people have already been on the internet’s Doctor Google before seeing me and this can be as helpful as it is frustrating and can potentially create more anxiety,” she said. Lorraine works closely with a team of cancer and general genetic specialists as well as local referring doctors whom she describes as ‘incredibly patient-focused and very supportive of what Lorraine can offer. “My role is one of a team

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summer 2015

and together we each play a unique and important part in patient care,” said Lorraine. Lorraine said that working as a genetic counsellor in an outreach situation, particularly part-time, could be very challenging – working as a sole practitioner with limited resources. “However, it is also the most rewarding and interesting profession as I am able to help with a really diverse number of genetic conditions. “I provide medical information about genetic disorders and risks that can help individuals make personal decisions about their own health, a pregnancy, or their child’s health care. These conditions often relate to a family history of cancer, a known genetic condition within the family such as muscular dystrophy, cystic fibrosis, Huntington’s disease, intellectual and developmental disabilities and many more.” Lorraine first worked at Port Macquarie in a job-share

situation with an amazing senior genetic counsellor who took Lorraine under her wing. “I could not have wished for a better role model and teacher and I am grateful for such a good start to my new career. Since then I have worked at Lismore, the Gold Coast and Kingscliff – all parttime positions in outreach centres.” As a career Lorraine has found it be very fulfilling and rewarding and would recommend it to others. “Because the field of genetics is ever changing, it is important that genetic counsellors stay up to date on current technologies and how we integrate this knowledge into our day to day clinical practice,” she told HealthSpeak.

Summary of GP Activity 2013/2014 The 2013/14 BEACH Report has been released. It’s a continuous national study of general practice activity in Australia and involves a random sample of 1000 practising GPs who record details of 100 patient encounters, information about themselves and their major practice. Below is some data of interest. General practitioners 57% male with 48% aged over 55 71% graduated in Australia 54% had provided care in an RACF in previous month 83% worked with practice nursing staff 70% reported using electronic records exclusively 43% worked in a practice with its own or cooperative after hours care The encounters On average, GPs managed 158 problems per 100 encounters Chronic problems accounted for 36%, and new problems

for 37% of all problems At an average 100 encounters, 103 medications prescribed/supplied or advised for OTC purchase, 49 pathology tests, 38 clinical treatments, 19 procedures, 15 referrals and 11 imaging tests The patients Females accounted for 57% of encounters; children under 15 years 11% 15-24 years 8%, 25-44 years 22%, 45-64 years 27% and over 65 years 32% Problems managed Most commonly managed were problems of a general, unspecified nature (20%); respiratory (19%), musculoskeletal (18%), skin (18%) and circulatory (17%). Most often managed individual problems were hypertension (8.7%), immunisation (5.8%), URTI (4.9%) and depression (4.3%). At least one chronic problem was managed at 42% of 100 encounters and 56 chronic problems managed per 100

encounters. Medications At least one medication was given for 51% of problems managed No repeats were given for 34% of prescriptions, and five repeats were ordered for 38% Most commonly prescribed medications – nervous system (24%), particularly opioids (7%), antidepressants (5%). For the cardiovascular system (19%), particularly anti-hypertensives and lipid lowering agents. Most commonly prescribed individual medications were antibiotics (cephalexin 3% and amoxicillin 3% of all scripts). Nervous system drugs - paracetamol (3%) and oxycodone (2%); and the proton pump inhibitor esomeprazole (2%) Referrals and admissions Six referrals recorded per 100 encounters or 10 per 100 problems managed Most frequently to medical specialists, then allied health

services. Very few patients referred to hospitals or EDs Tests and investigations GPs recorded orders for pathology tests/batteries at a rate of 49 per 100 encounters Chemistry tests accounted for 58% of pathology orders, the most common - lipid tests, multi-biochemical analysis, thyroid function tests and electrolytes, urea and creatinine Haematology accounted for 17% of pathology Almost 40% of pathology tests generated around 10 problems, led by diabetes, general check -ups, hypertension and weakness/tiredness. Eleven imaging tests ordered per 100 encounters. Diagnostic radiology accounted for 43%, ultrasound 41%, and computerised tomography 12% The report can be viewed here http://ses.library.usyd.edu.au//bitst ream/2123/11882/4/97817433242 26_ONLINE.pdf

A big welcome for the big bus The first leg of a North Coast tour by beyondblue’s big bus was a big success, with hundreds turning out to meet the beyondblue crew. The big blue bus visited Murwillumbah, Ballina, Lismore, Mullumbimby, Byron Bay and Grafton. In December it will be stopping at Valla, Port Macquarie, Kempsey and Coffs Harbour. The bus is also promoting the NewAccess program, a pilot mental health program run throughout the North Coast by North Coast Medicare Local. NewAccess is an early intervention program which provides accessible, free help for people with depression

five sessions and a review. Sessions can take place face to face or over the phone. People dealing with the following situations could benefit from NewAccess: Work stress or uncertainty with employment Change in living arrangements New parent worries, family problems Health concerns Isolation/loneliness Financial worries The bus stopped next to Ballina’s big prawn

and anxiety. It’s a beyondblue initiative funded by the Movember Foundation. The program is for those over 18 and aims to assist

people not currently accessing mental health services. NewAccess Coaches offer clients up to six free sessions, including an assessment,

HealthSpeak

NewAccess Coaches are located in major North Coast towns as well as Maclean, Yamba, Kyogle, Kempsey and Nambucca. To take action and get back on track, phone 1300 137 934.

A publication of North Coast Medicare Local

summer 2015

Journey through a research project

Infant Feeding Choices in the Northern NSW Aboriginal Community With a strong background in midwifery and Aboriginal and maternal health, Catherine Helps was well aware that while various health parameters were improving among mothers and babies, the low rate of breastfeeding remained a stubborn problem. “A lot of the women would start breastfeeding and be doing really well and they’d just quit really quickly,” she told HealthSpeak.

Catherine Helps

Getting started With a desire to explore this topic and with little research experience, Catherine took the opportunity to join the HETI rural research capacity building program and Professor Lesley Barclay at the University Centre for Rural Health agreed to be her research mentor. Her research motivation was to find out the reasons behind the short duration of breastfeeding among Aboriginal women in Northern NSW. Catherine emphasised that she would never have considered conducting this research (which produced the report Infant Feeding Choices in the Northern NSW Aboriginal Community) without her clinical experience in the local community. “Lesley has been very supportive and Emma Webster and David Schmidt who run the HETI program were really helpful as I went through the processes required – the ethics committee, designing the protocols, undertaking the research, typing up transcripts and making sense of the outcomes,” she said.

Methodology Catherine wanted the research to be qualitative, talking to women, and didn’t want to

Aboriginal women said they didn’t know many women who had breastfed, but most could say what infant formula their friends used

get into collecting data. She interviewed eight women who were having their first baby – only first babies so as not to confound the outcomes with previous experiences. In order to respect the women she was working with, Catherine used Indigenous methodology, working closely with Aboriginal mentors, Aboriginal health workers and getting advice from the Aboriginal Health and Medical Research Council. I wanted to make sure that I was consulting and not interpreting through my white middle class lens,” she explained. Through this process Catherine also realised that it’s not possible to separate the women’s infant feeding choices from what’s going on in the community. “I interviewed them during pregnancy and then again when the baby was about two months old. My exploration around breastfeeding or formula feeding included questions about their intentions, influences, expectations, what they thought might be barriers to breastfeeding and what their partners

HealthSpeak A publication of North Coast Medicare Local

summer 2015

thought of it. “ Catherine was intending to interview the women again at two months and six months, but it transpired that at two months none of them was still breastfeeding. All of these women had support from the Aboriginal medical services in the area – free unlimited access to care. All birthed at Lismore Base Hospital and appeared to have everything going for them to feel comfortable about breastfeeding. In addition to the eight Aboriginal mothers, Catherine interviewed five Aboriginal health workers as well as other mothers in the community, grannies and aunties - all with good insights into the community.

Insights Speaking with two Aboriginal women who were ‘breastfeeding champions’ in the community and speaking to the Aboriginal health workers were important turning points for Catherine’s research. “An important insight came

when I interviewed an Aboriginal health worker who told me about her grandmother who was removed from her community to go into service for a white family. While in service she became pregnant, she had her child removed and was made to breastfeed the child of the family she worked for – act as a wet nurse. “It made me think, hang on, there’s a lot of historical influences surrounding breastfeeding as well.”

Generational barriers Catherine then compiled a chart of the historical path since colonisation. She went through what infant feeding looked like before white settlement and looked at the history through the generations. She realised that the history the women shared about their mothers and grandmothers were not positive experiences, with children being removed or women being removed from the community having a huge impact on women’s choices about infant feeding. “Such events prove a big disruption to generational transfer of knowledge around breastfeeding, I found that was an underlying key issue,” she said. Key themes included: Women really wanted to breastfeed and knew that was what you were supposed to do. The message about

continued page 34 15

S & N donates furniture to The Winsome North Coast Medicare Local (NCML) is fortunate to have the support of two large pathology companies in distributing HealthSpeak to general practices – Sullivan & Nicolaides in the north of our footprint and Laverty Pathology in the south. Sullivan & Nicolaides recently donated some unwanted furniture to the GP Clinic operating at the Winsome in Lismore. The clinic was an NCML initiative in partnership with the NNSW LHD and St Vincent de Paul, as well as the Winsome volunteers and managers. The Winsome provides rooms for homeless men and also runs a soup kitchen for those in need and a coffee shop for the public in the old hotel in which it is housed. Vanessa Stewart from Sullivan & Nicolaides said she’d attended an NCML breakfast meeting where Winsome Centre

Vanessa Stewart with the old exam table S & N have donated to the Winsome clinic.

Manager Chris Murphy spoke and had been impressed by what she heard about the work of the weekly Wednesday morning GP Clinic. This prompted

her to offer some unwanted furniture items to the clinic including a quaint old examination table, a small desk, a phlebotomy chair to take blood,

three waiting room chairs, a handtowel dispenser and rubber glove holders. The clinic is going strongly with Dr Charlie Hew and Dr James Boyd working alternate weeks at the Winsome. During 2013/2014, the Winsome Clinic provided 226 GP occasions of service and 163 Community Nurse occasions of service to 77 patients. The majority of Clinic clients were men, with 15 per cent of clients identified as Aboriginal and/or Torres Strait Islander. The Clinic operates in the residential quarters at The Winsome for up to two hours on Wednesdays and offers a GP, clinical nurse services and mental health services free to residents and clientele of The Winsome. For more about S & N services, Phone 6620 1200 or 0428 604. 791.

Regional engagement pivotal to healthcare education By Prof Iain Graham Dean, School of Health and Human Sciences Southern Cross University

The year is drawing to an end, and for universities with Health Schools such as Southern Cross, consideration is still being given to the 2014 Federal Budget implications and the NSW health reform agenda. Change continues to be the dominant feature. At a time of change it is always sensible to connect with one’s roots and the School of Health and Human Sciences does this by hosting workshops in order to hear the views of our key partners and stakeholders with regard to potential developments. The three workshops we hosted this year were: The future of post graduate education for the health professions, The changing nature of residential and aged care, with

its implications on the workforce and latterly research; be it clinical in nature, or translational in interpretation. The need to understand its impact on health service design and activity and evaluating its effect on patients have all been a feature of our debates. It is out of such debate that the School shapes its annual operational plan. And it is out of such activity that the School has introduced new programs including allied health programs in occupational therapy, speech pathol-

ogy, podiatry and pedorthics. Over the next two years we will hopefully offer courses in bio-medical science, behavioural science with health informatics, and Indigenous health. We also need to ensure students know how to learn about knowledge, its management, evaluation and retrieval. As we stand at the cusp of the 21st Century, we are entering a new era of healthcare driven by two intersecting scientific tidal waves: genetics and digital technology. Over the coming months we hope to establish some clear strategies of development in the fields of both post graduate and health practitioner education and research. Work is occurring to place honours students within the health service in order to help build a clinical research culture. Development of nurse educators and clinical nurse consultants is another aspect

HealthSpeak

we will be pursuing. The school is picking up the theme that learning needs to be flexible and accessible, delivered in as short a timeframe as possible. Practitioners will need to invest in continuing personal and professional development to maintain capability for learning, not just competence in skill sets. Change is always present but in a globalising world of free trade agreements, the education of health practitioners will be forced to change. The School wants to be a leader in this change. We can only achieve this if we have the right regional engagement mechanisms in place to discuss with stakeholders as we grow. We need to ensure that we use these mechanisms to help create a new type of Renaissance. Such a movement is much needed if we are to find the solutions we need to achieve the health system we all desire.

A publication of North Coast Medicare Local

summer 2015

What is dietetics? Dietetics is the study of the relationship between nutrition and health. Those who work in dietetics are called dietitians. Dietitians apply the art and science of human nutrition to help people understand the relationship between food and health and make dietary choices to attain and maintain health, and to prevent and treat illness and disease. The roles of a dietitian include Collecting, organising and assessing data relating to the health and nutritional status of individuals, groups and populations Interpreting scientific information and communicating information, advice and education to individuals, groups and communities

Managing nutrition care for individuals by planning diets and menus, advising on nutritional needs and ways of accessing and preparing food Planning, implementing and evaluating nutrition programs with groups or populations as part of a team Managing food service systems to provide safe, nutritious food designing and implementing nutrition policies Undertaking food and nutrition research. In Australia there is a distinction made between dietitians and other occupations in the nutrition and food science field, including that of nutritionist. All dietitians are considered to be nutritionists, however, nutritionists without a dietetics qualification cannot take on the

role of a dietitian. A dietitian has undertaken study that includes assessed professional practice in clinical nutrition, medical nutrition therapy and food service management.

Where dietitians work Patient care: assessing the nutritional needs of patients, planning diets and educating patients and their families. Public health: working in nutrition and in health education programs. This can be at the local community level or at a national level. Dietitians in public health also assist with health planning, setting nutritional standards, and developing nutrition policies. Food management: combining management skills and nutrition expertise when in hospitals, nursing homes, hospitality and

catering. Dietitians also manage nutrition services and health programs. Consultancy/ private practice: providing consultancy services Food industry: dietitians are involved in food safety regulation and quality systems, education, research, product development and marketing. Research and teaching: working in research teams and developing recommendations, training students and health professionals. Information from Dietitians Assocation of Australia website: http:// daa.asn.au/

Profile Dietitian Johanna McCallum Even as a teenager, Johanna was interested in working in the health science field, initially considering becoming an obstetrician. Her first degree was a Bachelor of Science degree in the US, majoring in biology with a minor in anthropology. Johanna then applied to medical schools in California, but her heart was calling to move to Australia. After arriving here, she took some time off from study. After a time, Johanna decided to go back to university so that she would have a profession she could rely on. “I was living in Berry in southern NSW at the time and was accepted to study nursing at the University of Sydney and dietetics at the University of Wollongong. Because I didn’t have my heart set on one or the other, I chose the course closest to home.” Johanna told HealthSpeak that she was always interested in fitness and nutrition and knew that she could help people make better choices when it came to nutrition. Two years later her first position was part-time at Shoalhaven Hospital in Nowra. “Soon after, I started consulting at Nowra Private Hospital (Ramsay Health)

and I also worked on a pilot project in eating disorders at the Nowra Community Centre, a challenging role for a new graduate.” A couple of years later, Johanna had her first baby and the family moved back to California, requiring her to get qualified as a Registered Dietitian in the United States. After some more study and practical work, Johanna worked for Scripps Green Hospital as a clinical dietitian for six years. “I had the opportunity to expand on my skills and engage in new areas. I most enjoyed working in the Intensive Care Unit and helping patients in the Liver and Kidney Transplant Unit,” she said. Six years ago, Johanna and her family returned to Australia and she began working as a consultant at Lismore Private Hospital. When the hospital closed, she moved to John Flynn Hospital, taking up the role of Lead Clinical Dietitian. “The majority of my work at John Flynn is in the Oncology and General Medical wards. I love working with the cancer patients. It is very rewarding and challenging at the same time. Our oncology patients usually have a longer stay and some are “frequent fliers”, so I can

HealthSpeak A publication of North Coast Medicare Local

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build a real rapport with them. “I also run a private practice once a week. I do home visits and also consult at a few nursing homes in Ballina and Byron Bay. For Johanna, dietetics is interesting, ever changing and challenging and a portable profession she can use around the world. “Every client is an individual and needs specialised support. It is a reliable job and one which fits well with my personal and family life.” As a career path, Johanna says it’s a great profession, with many different avenues (see article above). While Johanna says she used to regret not having followed her childhood dream of becoming a doctor, looking back, she’s happy about the choices she made. “I am glad I became a dietitian as I think it has enabled me to live a healthy life, without the crazy hours and stress that other careers may frequently be associated with.”

Understanding Compassion Fatigue By Daniel Mason This article is to help raise awareness about compassion fatigue within the health care community. It has been written as a result of Sawtell GP Harriet Playle’s PITCH (Practical Ideas to Improve Health Care) to North Coast Medicare Local on the topic. Compassion is defined as a deep sympathy and concern for the suffering of others. Health care professionals spend a significant amount of their time caring for the wellbeing of others, drawing on a deep wellspring of compassion and empathy. But what happens when the well runs dry? Sometimes, caring for others can profoundly affect the ways in which we care for ourselves. The clinical environment has become increasingly demanding, with big workloads, long hours and frequent exposure to injury and distress. These stressors have resulted in high rates of depression, anxiety, substance abuse and suicide among health care workers. Compassion fatigue can affect anybody who provides health care. Constant exposure to the suffering of others – and a repeated inability to alleviate this suffering – can have a detrimen-

tal effect, wearing people down and ultimately affecting their ability to feel empathy for patients and others around them. Like burnout, compassion fatigue manifests as an overwhelming physical, emotional and spiritual exhaustion, leaving health care workers in a state of apathy and emotional detachment. Often these feelings go unspoken, as people can feel ashamed to put their needs before their patients. Instead of confronting these negative emotions, these caregivers go about their job with low morale, feeling helpless and running on empty. They can no longer summon the compassion their work requires. Symptoms of compassion fatigue include:

Irritability Sleeplessness Intrusive thoughts Depression and anxiety

The person affected no longer finds satisfaction in their job, they lose their sense of purpose, becoming withdrawn and isolated. This can lead to frequent absenteeism and a lack of self-care. These workers might resort to substance abuse or other behaviours to deal with their negative feelings. Left untreated, compassion fatigue is extremely damaging to health and can ultimately affect the level of care that patients receive, too. Awareness is the first step to overcoming compassion fatigue, as the condition is both treatable and preventable. Because compassion fatigue affects the whole person – mind, body and spirit – it is essential for health care workers to prioritise their emotional, physical and spiritual needs. A person who understands and cares for their own needs is better positioned to respond to others.

New MRI Service for Ballina North Coast Radiology is pleased to announce the installation of a stateof-the-art Siemens Aera 1.5 T MRI at its Ballina branch on Tamar Street. The addition of this new MR scanner complements a large array of imaging equipment. This enables North Coast Radiology to deliver the most comprehensive range of Radiology services for Ballina under one roof. The new service will be reported on by our specialist MR Radiologists and manned by an experienced MRI team. Features of the new MR scanner include a short, wide bore with very low noise. This lowers anxiety levels, facilitates larger people and is perfect for claustrophobic patients.

Strategies for preventing and treating compassion fatigue are essentially the same as maintaining a healthy lifestyle. Avoid compassion fatigue by: Getting sufficient sleep Eating regular healthy meals Exercising and making time for enjoyable activities Maintaining social connections Discussing feelings with collegaues or asking your GP for help Not taking on more than you can handle Identifying negative thoughts and replacing them with a more positive outlook It can become all too easy for caregivers to neglect their own health in the fog of compassion fatigue. Drawing from their well of compassion should never come at the expense of their own health.

Advertorial

The state of the art scanner comprises top of the line technology allowing for quicker, clearer pathology visualisation. The new MRI scanner does not have a license for Medicare rebates (due to present Federal Government policy), and consequently under present legislation MRI scans performed at Ballina, cannot be bulk billed. The new MRI is capable of scanning an extensive range of examinations. The new MRI service is operating from 8.30am to 4.30pm Monday to Friday at North Coast Radiology Ballina. For bookings and appointments please call 6618 2900. More information is available at www.ncrad.com.au

HealthSpeak

The new MRI machine’s giant magnet going into position at Ballina.

A publication of North Coast Medicare Local

summer 2015

Lismore GP Super Clinic continues to expand HealthSpeak visited the Lismore GP Super Clinic in late August after the construction of the new clinic had been completed. Formerly Meridian Health, the practice won the tender to become the Lismore Super Clinic in late 2011 and three years later it has been transformed into a purpose-built clinic on three levels. The spacious reception and waiting room areas are decorated with artworks by Indigenous artist Paddy Fordham, a favourite artist of co-owner John Brice. Framed footy jerseys attest to Mr Brice’s support of local Indigenous football players. Dr David Stirling is the clinic’s Medical Director and he told HealthSpeak that it was a pleasure to come to work in the new building which is fitted out with state of the art equipment. The clinic has five medical practitioners, three of whom bulk bill entirely and two who do mixed billing. “We have a developing range of allied health practitioners, and on September 8 the five chair Dental Suite was leased by Ballina-based dentist Kim Davies who caters to all elements of society by pricing her services quite favourably, so we’re looking forward to making a significant improvement in dental care and we’re very happy about that,” said Dr Stirling. The allied health team currently comprises an exercise physiologist, a psychologist, an orthotist and a podiatrist with an application pending for a pharmacy on street level. QML Pathology is housed in the clinic complex, adjacent to reception. Dr Stirling explained that the model of care in operation at the clinic was one where a registered nurse works with each doctor to the benefit of patients. Their rooms are across a corridor from each other and they can consult about a patient and the nurse can attend to the patient during the consultation with the doctor.

Framed footy jerseys attest to Mr Brice’s support of local Indigenous football players

Super Clinic staff Shae, Susan, Peta, Julie and Dr David Stirling.

He and his wife Susan, who does admin work for the doctors and supports them in chronic disease management, said the clinic had a happy and positive atmosphere. Dr Stirling is also enjoying mentoring medical students and being heavily involved with the medical and service processes at the clinic. “I wanted the opportunity to expand what I do and this role gives me that opportunity. I came here because I looked around and thought it was the best run organisation offering medical services,” he told HealthSpeak. On a tour of the clinic,

Susan pointed out the allied health wing, the dental suite, the meeting room also used for education and community events, and the Medical Staff Respite Suites (all on the top level). There is also an emergency room/treatment room with a bed equipped with everything you’d see in a hospital. Susan said the previous week there had been three patients who came in and needed an ambulance. She explained that staff felt safe having the emergency room there, where they could stabilise patients before the ambulance arrived. The room is also used as a

procedure suite for Dr Craig Russell from Toowomba who attends the Super Clinic each month with his theatre nurse to perform skin excisions. The suite is fitted with negative air flow and hepa filters to minimise the chance of infection. Close to a separate entrance, is a reception area which will be used for the after hours service when it is up and running. Also located within the Medical Centre complex is the suite leased by ophthalmologist, Dr Steven Rodwell. At the end of the tour Susan paid tribute to the clinic’s staff. “Our staff are just wonderful and management is very supportive with resourcing, it’s a moving forward, happening place,” she said with a broad smile.

Asthma InfoLine referrals The Asthma Foundation of NSW offers a free service to help support patients and those who care for someone with asthma. Referrals are made easy by various methods including as a Medical Director post prescribing prompt, in an easily downloadable form in Best Practice and Zedmed, hard copy form or directly via our website (www.asthmaaustralia.org.au/Health_Professionals/InfoLine-Referral.aspx) Patients receive upto -date, evidence-based information, education and

HealthSpeak A publication of North Coast Medicare Local

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support from health professionals within two working days of referral. We aim to help improve asthma control and self-management by encouraging better compliance with medications and advice given by the GP. Feedback is available on your patient and patients are encouraged to see their GP for regular review. For more information on the service or process, as well as information about practice resources, please contact Robyn McKern at rmckern@asthmafoundation. org.au or call on 9018 0509.

The Koori Grapevine Monthly Health Information events at Bowraville NCMLâ&#x20AC;&#x2122;s Closing the Gap team has partnered with Ngambaga Bindarry Girwaa Aboriginal Community Service Inc in Bowraville to host health information days once a month for Nambucca Valley Aboriginal and Torres Strait Islander residents. Closing the Gap project officer Helen Lambert told HealthSpeak that the vision for these events was to provide information on health-related topics such as diabetes, vision, hearing, foot care, dementia, falls prevention, nutrition, cancer, cardiovascular disease, renal and respiratory health. The one-hour information sessions are led by health educators who provide information on their topic, practical solutions to improve health, and answer questions. The ses-

Falls prevention expert Frank Stewart at the Ngambaga Bindarry Girwaa offices in Bowraville.

sion is followed by lunch and yarning. The sessions are delivered in an informal way to encourage interaction and to provide a

culturally safe space for those attending. In September, the topic of the month was Falls Prevention and Frank Stewart, a Falls

Deadly Sisters Event in Casino Solid Mob and the Northern NSW Local Health District Quit for New Life team joined forces in September and held a Deadly Sisters Event in Casino. The focus of the day was on Aboriginal and Torres Strait Islander women, women with babies, pregnant women and young women and local programs. Tackling tobacco and smoking cessation was the priority. The day was organised to showcase a range of local programs, activities and resources suitable for Aboriginal women. The Northern Rivers Regional Tackling Indigenous Smoking and Healthy Lifestyle Program (SOLID MOB) is based in Ballina but works across the Northern Rivers from Tweed Heads to Grafton and inland to Tabulam. It is comprised of a team of six Tobacco Action and Healthy Lifestyle Workers who work with communities to raise awareness of the health impacts of tobacco smoking and chronic disease. Solid Mob provides a range of activities to support and encourage smoke-free environments, educate and promote quitting and encourage healthy lifestyles. The Quit for new life (Q4NL) program is a state-wide program which commenced

Koori Grapevine

The eventâ&#x20AC;&#x2122;s focus was tackling tobacco addiction with a focus on young women.

in Northern NSW in October last year. The Northern NSW Q4NL program is rolled out across the area by NNSW Health Promotion. The Quit for New Life team works with key health practitioners, offering antenatal

Prevention Officer from Mid North Coast Local Health District talked about falls awareness. In addition, two presenters from Guide Dogs Australia talked about the practical sight aids they can provide free of charge. Eleven people attended and referral forms are being made up for the two topics. The information sessions are held every second Monday of the month from 11 am to 1pm at the Ngambaga Bindarry Girwaa offices at 53 High Street, Bowraville. Helen said interest in the sessions has been high and educators are booked to deliver sessions through until January next year. For more information, phone Helen Lambert on 6659 1800.

and post natal care for pregnant Aboriginal women, women having Aboriginal babies and their household members. The program operates between Tweed and Grafton and out to Tabulam and Bonalbo. It supports participants to quit smoking and create smoke free homes and environments for mothers, babies and families. Cessation Support Officers follow up clients and participants are provided with ongoing smoking cessation care, and if clinically appropriate, provided with free Nicotine Replacement Therapy (NRT). Household members are also able to receive help and are offered Quitline and free NRT if appropriate after they are assessed. Once enrolled in the Quit for New Life program both pregnant women and household family members are entitled to 12 weeks supply of free NRT. Between October 2013 and August 2014, in Northern NSW there were more than 88 referrals to the Q4NL program. Deadly Sisters Days will be held throughout the North Coast in different locations over the next few months. For further information on the Quit for New Life program, contact Quit for new life Cessation Support Officers North 0477 368 180 or South 0477 368 182.

A publication of North Coast Medicare Local

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NACCHO calls for investment in Aboriginal health services A peak Aboriginal health body has told a Senate committee that the proposed GP co-payment and changes to the PBS would discourage Aboriginal and Torres Strait Islander patients seeking preventative health care and impact on efforts to close the gap in Aboriginal life expectancy. The National Aboriginal Community Controlled Health Organisation (NACCHO) submission to the Senate Select Committee on Health also calls for a recommitment to health promotion and early intervention programs and for a particular focus on Aboriginal and Torres Strait Islander-specific health initiatives. The NACCHO submission said health policy should recognise Aboriginal people’s increasing preference to use

Aboriginal Community Controlled Health Services over mainstream services and ensure funding keeps up with demand and inflation. “As a nation we must look for ways to improve the health of Aboriginal people and invest in programs and services that are working for Aboriginal people,” Mr Mohamed said. “We must encourage Aboriginal people to get regular check ups, to see their GP and to participate in initiatives that promote healthy lifestyles. “The introduction of extra expenses such as GP co-payment and a rise in the cost of PBS medicines will discourage Aboriginal and Torres Strait Islander people to seek preventative health care and impact on their long-term health. “The additional expenses

Justin Mohamed

will also seriously affect the long term sustainability of Aboriginal Community Controlled Health Services, most of who will not pass on the charges to patients. “For the sake of the health of Aboriginal men, women and children, these proposals must be rejected,” he said.

Mr Mohamed urged the Senate committee to focus on preventative health measures which deliver long-term benefits through improved health and wellbeing and reduce the burden on the healthcare system at the tertiary and acute end of care. “The NACCHO submission also calls for ongoing culturally-appropriate health programs that are specifically designed and run-by Aboriginal people as we know these have the greatest success,” Mr Mohamed said. “In particular, Aboriginal and Torres Strait Islanderspecific population health initiatives and child and maternal health programs must be maintained to ensure we continue to close the gap on life expectancy and infant mortality.”

New research to prevent Indigenous youth suicide Four new National Health and Medical Research Council (NHMRC) grants have been awarded to put a stop to escalating rates of Indigenous youth suicide. The grants are the result of an NHMRC Targeted Call for Research, a scheme which enables the Council to fund research into urgent health priorities. “NHMRC’s targeted calls for research allow us to ‘commission’ research in areas of high need, and Indigenous youth suicide certainly qualifies as a priority. Young Indigenous Australians have the highest reported suicide rates in this country, which is just devastating,” NHMRC CEO Professor Warwick Anderson said. In 2010, suicide rates for Aboriginal and Torres Strait Islander females aged 15 to19 years were 5.9 times higher than those for non-Indigenous females in this age group, while for males the corresponding rate ratio was 4.4. “The suicide issue is complex to tackle and research so far has

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Grant details

Professor Warwick Anderson

indicated that there are many complicating factors that contribute to people taking their own lives. These grants aim to build on this research and find ways to prevent suicide in future,” said Prof Anderson. The grants fit with the NHMRC’s commitment to improving health outcomes of Indigenous Australians by ensuring 5% of all funding is directed to researchers conducting Indigenous health research. “Indigenous health issues are our nation’s responsibility to solve so it is important that NHMRC funds high quality research that can make a lasting difference,” Prof Anderson said.

A publication of North Coast Medicare Local

Dr Roxanne Bainbridge, James Cook University ($824,876) Dr Bainbridge and her team will implement a mentoring program to help Indigenous students who have moved from remote communities to attend boarding schools across Queensland. This program will seek to improve students’ psychosocial resilience; the mentors will be supported throughout and the impact of the program will be measured. Dr Maree Toombs, University of Queensland ($804,737) Dr Toombs and her team will develop a training program that links health providers, community members, peers, school leaders and mentors. The program will include members who will serve as “gatekeepers”, identifying atrisk youth and referring them to specialist health professionals. Dr Toombs will also use new technologies such as

a smartphone application and social media to help implement and assess the program. Professor Anthony Jorm, University of Melbourne ($1,140,372) Professor Jorm and his team will develop new guidelines to support Indigenous communities to prevent suicide and self-injury amongst their young people. Community members will be trained to act as gatekeepers, identifying young people who are at risk and referring them to health workers with greater health expertise. Associate Professor Gary Robinson, Menzies School of Health Research ($1,745,899) Associate Professor Robinson will trial an intervention that aims to build resilience and social-emotional skills among middle school aged youth in remote Indigenous communities of the NT. This intervention is intended to form part of a community-based suicide prevention strategy.

Koori Grapevine

Arts Health and Wellbeing It takes a whole village to make a play

Photos by Sri Dharma.

It takes a village to raise a child African Proverb By Janis Balodis It Takes a Village: And Other Lessons Children Teach Us is a book by Hilary Rodham Clinton. Clinton focuses on the impact individuals and groups outside the family have, for better or worse, on a child’s wellbeing, and advocates a society that meets all of a child’s needs. Clinton says she chose that African proverb as her title because it offers a timeless reminder that children will thrive only if their families thrive and if the whole of society cares enough to provide for them. Substitute the word “children” with “anyone with a disability” and the concept and ideas have even more stark and important implications. It Takes a Village is a play created and performed by the Multitask Drama Group, adults with disabilities from the Lismore community and surrounds. Written and directed by Ajita Cannings, audio-visual design by Ryan Andersen and Zeb Schulz, guitarist Chris Mallory and production by Trinity Year 11 VET students. Multitask staff members and volunteers provided support for the actors during the rehearsals and performances. Ajita Cannings and the group devised the story during two hour long drama sessions conducted twice a week over nine months. A flood isolates the village of Hidden Waters. The inhabitants find a baby and have to take care of it. Some like the baby, some 22

Ajita Cannings directing The Authorities in masks

want it gone, and everyone has an opinion about what is the best for the child. The villagers realise they must use their talents and cooperate to take care of the baby and return it to its mother. But how on earth do you change a nappy? It was a humorous and poignant tale about the test of friendship and a tribute to love and letting go. Multitask’s mission is to provide opportunities for growth, development, support & security for people with disabilities and their communities. To a large extent this underpinned both the form and content of the play. Ajita Cannings began improvising with people of different levels of ability to find out what they could do and wanted to do as individuals and as a group; acting the goat that didn’t want to be milked, or a dancing policeman in a long blond wig. Shaping and assembling these little routines into a narrative created the play. Ajita comes from a circus and community theatre background. Her philosophy is to create theatre that shows how we can be together. “I don’t believe there is a strong

delineation between theatre and life. The more we can involve creativity as part of our everyday lives the better the opportunities for learning, for better health, and for better relationships.” This focus made Ajita Cannings an ideal facilitator for this play. The excitement, joy and sense of achievement of the performers, and the appreciation and pride of the support staff and the families and friends who attended made for a captivating and entertaining event. It took a small village to make this play and put it on, a small village of insiders who already believe that arts have a role to play in health and well-being of people with disabilities. At the recently held 6th Annual International Arts and Health Conference in Melbourne, plenary speaker Mike White from the UK offered these observations; “It was invigorating to step through an arts in health conference that is not obsessed with the evidence base for art as an ancillary treatment…” And particularly appropriate to the outcome of this project, “What appears to be missing, however, is a focus on workforce development and the role of education in embedding arts in health through the life course.” What Mike White is implying is that it is the responsibility and role of the whole larger village, of all of us to not only promote the message but also to actively engage in such play that includes everyone in creative and healthy living. I hope Multitask and Ajita Cannings can continue to develop this creative playmaking project next year. And that more of the village get to share in the raucous fun. HealthSpeak

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The healing art of transformation By Janis Balodis The artist is a receptacle for emotions that come from all over the place: from the sky, from the earth, from a scrap of paper, from a passing shape, from a spider’s web – Pablo Picasso A Wiradjuri woman born in southern Sydney, Karla Dickens is now based on the North Coast and has been a practicing artist for more than 20 years. She trained at the National Art School in Sydney and has been driven to create art since she was a child. Prolific and hard working, Dickens is increasingly in demand for group and solo exhibitions. And her work features in the collections of many regional and national galleries. Dickens recycles found and discarded materials fossicked from rubbish tips to create her collage-based works and her three-dimensional sculptures. Old cages, pieces of fabric, leather, plastic, feathers, wire masks, dog muzzles, scrap metal and bone are already steeped in history and emotions associated with their former use and existence. Dickens gives them new life, transforming colonial waste and surplus into Aboriginal creations of unsettling beauty that reflect on and challenge our accepted understandings of Australia’s history, both past and present. Dickens acknowledges the healing capacity of art. “My art is such a big part of my life and I’ve seen so many people actually heal when they have some way to express themselves.” Initially the work she makes is for her own healing but she admits that she’s heard it has this effect upon others in the community. “I don’t try to speak about other people’s pain.” Working across a wide array of media, her art is an expression of deep personal experience, in sexuality, motherhood, the strength and resilience of black women, a complex

Karla Dickens

Transforming colonial waste and surplus into Aboriginal creations of unsettling beauty

spirituality, and her need to ask questions and speak about contemporary Aboriginality in Australia, with a desire for change. Things are never as they first appear in Dickens’ creations when the mix of objects, patterns and decoration captivate. On further contemplation one becomes aware of her sharp wit and a subtle and persistent statement that things cannot remain the same. Healing demands that things change. Healing and art both require processes of transformation.

HealthSpeak A publication of North Coast Medicare Local

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Karla Dickens’ “January 26, Day of Mourning” was the winner of the 2013 Parliament of NSW Aboriginal Art Prize. Embroidering a tattered old Australian flag with Aboriginal symbols and embellishing the Union Jack with lace rosettes that resemble a wreath, Dickens makes a powerful statement about grief. “The majority of Australia celebrates 26 January… I cringe … and respectfully hold my grief – the grief for the old, grief for the continuous denial, grief for the disrespect, grief for

the lack of acknowledgement and the poor choice of the day to celebrate. After finding the flag at the tip, I went about hand sewing my grief, with one cross after another. Unfortunately, it’s only a small gesture to reflect the true loss.” The application of embroidery and lace to an overtly nationalistic and masculine symbol has an effect that is softening, and feminine. When the work was accused of being provocative, Matt Poll, one of the prize’s judges said, ‘’I think provocative is too strong a word. I think it’s about embroidery and the feminist practice of making things your own.’’ Once again, in seeking her own healing through art, Karla Dickens has created a beautiful and subversive work that urges all of us to think about how we might heal ourselves, and this nation. Karla Dickens is represented by Andrew Barker Art Gallery Brisbane, and her work can be viewed online at: www.karladickens.com.au/ 23

John Vaughan wins GPET’s Supervisor of the Year For three decades, Dr John Vaughan has supervised GP registrars and medical students and his dedication and skills have now been recognised with a national award - GPET’s Supervisor of the Year for his work with North Coast GP Training (NCGPT). John works full-time at the Ocean Drive Family Practice in North Haven, south of Port Macquarie. It was his own GP, a garrulous and knowledgeable English doctor, who inspired John to pursue a career in medicine. John attained a Bachelor of Pharmacy and then a MBBS from the University of Sydney, before embarking on internship and residency at Royal Newcastle Hospital (now John Hunter). “I left in my third year to work at Redfern Aboriginal Medical Service and I was the first GP at Purfleet Aboriginal Medical Service near Taree working with the extraordinary Pat Davies who was the driving force behind setting it up. She used to call me ‘Trapper John’!” John then went into general practice on the Central Coast with Geoff Whyte, a colleague from university, where he

To watch them develop into sound, independent GPs is wonderful

Well deserved: John Vaughan at the awards ceremony

worked for 25 years. “I worked as a VMO at Wyong Hospital from 1985 until 1995 and became a supervisor in 1985 with the old Family Medicine Program when the terms were three months. I spent six months in 1990 working in PNG in a hospital

Resource for carers CareSearch has released a new resource for patients and their carers called My Information Kit. It allows health professionals to select relevant factsheets that are automatically compiled and can be printed out or emailed to patients and carers. My Information Kit makes it easy for GPs, nurses or palliative care specialists to choose information useful to their patient and even attach a cover sheet including their name and contact details. The resource allows users to choose factsheets from the Australian Centre for

Grief and Bereavement, Palliative Care Australia and CareSearch. These cover a range of issues relevant to carers, including managing medications, practical caring information and information on grief and loss. These factsheets are written to provide trustworthy, easy to understand palliative care information. Topics include coping with holidays; financial issues; asking for help and finding support. These factsheets are available in the Patients, Carers and Families section of the CareSearch website at www. caresearch.com.au

near Rabaul, probably the most enjoyable part of my medical career.” After attaining his FRACGP in 1993 from general practice, John continued supervising until 2001 when he was involved in setting up Valley to Coast and became the chair of that Regional Training Provider He also worked as a supervisor there. “In 2005 I left to work in the Torres Strait as a Senior Medical Officer, spending ‘three wonderful years’ in primary care on Thursday Island and the 15 outer island clinics that we visited regularly. “I also had the privilege of supervising registrars in the Torres for TMT training,” he told HealthSpeak. It was in 2009 that John returned to the Camden Haven area where he was born and began practicing at North Haven, assuming the role of a supervisor and of Supervisor and Liaison Officer for NCGPT. John explained that the role of a supervisor requires a commitment in terms of time, enthusiasm and, most essential, keeping up to date. He said training young doctors has kept him on his HealthSpeak

toes and stimulated his own learning. “To be involved in the development of the young, enthusiastic registrars over the years has been a rewarding endeavour, to the extent that I am still in touch with many I have had the fortune to practice with. “To watch them develop into sound, independent GPs delivering good primary care – the most important aspect of our health care system – is wonderful,” he said. Many of the registrars that John has supervised have gone on to become supervisors themselves, and medical educators and academics. When he’s not doctoring, John enjoys surf patrols at the Bonny Hills surf club where he also competes in Masters’ competitions. Staying active is important to him and this includes a good diet as well as regular exercise. He also runs a boot camp three days a week for surf club members and associates. John has also worked in the Pitianjarra homelands in northern South Australia, doing locums there in the 1980s and taken on voluntary medical assignments overseas, most recently in Nepal with his wife Margaret. He is still mentoring an Indigenous registrar in Taree who works at Purfleet Aboriginal Medical Service and who has now attained his Fellowship. John is also remotely supervising a senior registrar at Werrin Aboriginal Medical Service in Port Macquarie. North Coast Medicare Local congratulates John on his dedication in the important role of mentoring young doctors and promoting health and fitness in his community.

A publication of North Coast Medicare Local

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Creative doctor wins national award North Coast GP Dr Genevieve Yates has been awarded the prestigious General Practice Education Training (GPET) Australian Medical Educator of the Year Award. A Medical Educator and Associate Director of Training for North Coast GP Training (NCGPT), Genevieve was acknowledged for her work training the next generation of doctors for the Northern Rivers Region. Genevieve lives in East Ballina and wears many professional hats. In addition to her work for NCGPT, Genevieve works for MDA National (designing and delivering medico-legal education), the Royal College of General Practitioners (as an educator and examiner) and as a medical writer (columnist, novelist and playwright). She also plays violin, piano, and sings. This year’s national GPET award was shared with Victorian doctor, Dr Gerard Ingham, who shares Genevieve’s love of medicine and the creative

Partners in Prevention Symposium

Assoc Prof Richard Matthews, Dr Genevieve Yates and Dr Gerard Ingham

arts. Coincidentally, Gerard and Genevieve co-wrote and co-produced “GP the Musical”, which has been performed in Melbourne, Daylesford and Darwin, and had a sell-out season at the Melbourne International Comedy Festival last year. Genevieve was not only nominated for the award by her peers at NCGPT but also by numerous junior doctors she trains and mentors. Local reg-

istrar Dr Clare Collins has said “Genevieve consistently goes above and beyond for NCGPT registrars. Her caring, passionate and enthusiastic manner is inevitably a large driving factor for our continuing success”. Genevieve has said of her award, “I am thrilled and humbled to receive this award and I’m utterly delighted to share it with Gerard who has been a good friend for many years.”

Breast screening interval guidelines BreastScreen NSW routinely offers screening mammograms to most women every two years. For some women, however, annual screening is available. The recommended breast screening interval is determined and/or reviewed when a woman presents for her routine screening appointment. Since November 2014, eligibility for annual screening is being determined against the following criteria: Previous diagnosis of breast cancer – this includes invasive and in-situ cancer sub-types. BreastScreen NSW recommends that women with a previous history of breast cancer should be at least five years post-diagnosis before re-attending a BreastScreen service. However, policy allows for annual rescreens for all women diagnosed with breast cancer on the advice of her specialist.

Previous benign biopsy – in which any of the following features were identified: Atypical ductal or lobular hyperplasia, Lobular carcinoma in-situ. Family history – BreastScreen NSW routinely offers annual screening to women who have a first-degree relative (mother, sister, daughter, father, brother, son) who was diagnosed with breast cancer before age 50. A woman can have her screening interval reviewed further if she has concerns about her family history and either herself or her doctor request an additional review. If a review is requested, the woman’s screening interval will be determined by the applicable category recommendations outlined in the Cancer Australia Familial Risk Assessment – Breast and Ovarian Cancer (FRA-BOC) online tool. This tool categorises

HealthSpeak A publication of North Coast Medicare Local

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women into three levels of risk for breast cancer according to family history. If a woman is confirmed to be in risk category 1 or 2, she will be offered biennial screening. If a woman is confirmed to be in risk category 3, she will be advised to see her doctor for discussion and possible referral to the most appropriate clinical service. If the client wishes to remain with BreastScreen NSW, she will be offered annual screening upon informing the program of her decision. To access the online tool, visit: www.canceraustralia. gov.au/clinical-best-practice/ gynaecological-cancers/fra-boc/ evaluate Specialist recommendation – If a designated radiologist and/or multidisciplinary team decide that a patient requires annual screening, this will be offered by the BreastScreen NSW Program.

North Coast Medicare Local in partnership with the Mid North Coast Local Health District, ACON and GenHealth is coordinating a Health Symposium in February next year. The Symposium on February 26 will bring together participants from a variety of organisations with a Health Promotion focus. This will include health professionals, local councils, aged care providers, Aboriginal medical services, and representatives of Mid North Coast Local Health District, Medicare Local, and NGOs with a preventative health focus. It’s anticipated there will also be representatives from other sectors including transport, Centrelink and community housing. The goal of the day is to draw up an action plan for the Health Promotion Alliances on the Mid North Coast and Northern NSW to develop stronger relationships and partnerships for North Coast Communities The keynote speaker will be Christine Morgan, the CEO of Butterfly Foundation and her address will be on the theme of the Symposium “Creating Supportive Environments”. For further information, phone 6659 1800 or register online at www.trybooking. com/111298

Help needed with musculoskeletal project North Coast Medicare Local is excited to be involved in an innovative project called the Mid North Coast Musculoskeletal Initiative for Primary Health Care (MNC MSKIPHC). The MNC MSKIPHC is a pilot project led by the NSW Agency for Clinical Innovation (ACI) to trial the implementation of three evidenced-based models of care pertaining to specific musculoskeletal conditions; 1 Osteoarthritis Chronic Care Program (OACCP) 2 Osteoporotic Refracture Prevention (ORP) 3 Management of Acute Back Pain (MABP) Musculoskeletal conditions are conditions of the bones, muscles, joints and ligaments and are the most common chronic diseases in Australia, affecting 28% of the population. While there are more than 100 recognised musculoskeletal conditions, the Australian Institute for Health and Welfare has identified osteoarthritis, osteoporotic refractures and acute back pain as contributing disproportionately to this burden of disease. Consequent-

ly, the ACI Musculoskeletal Network has focussed on these conditions to develop models of care to optimise service coordination and primary health care delivery. Recognising an opportunity to improve the health status and quality of life of the people of the Mid North Coast; North Coast Medicare Local (NCML), in collaboration with the Mid North Coast Local Health District (MNCLHD), successfully submitted a joint proposal to be included in the pilot. Significantly, the Mid North Coast was one of only three trial sites chosen across NSW to implement the pilot. NCML aims to adopt a collaborative approach between general practice and other primary health care sector service providers, specialist services and hospitals. This multisector and multi-disciplinary teamwork is necessary to integrate the three models into the patient-centered health home/ neighborhood model of care as best practice. However, NCML acknowledges that implementing evidence based practice and the seamless transition of care between sectors of the health system is challenging.

Managing acute back pain is one of the care models being implemented in the project.

In order to overcome these barriers and make the pilot relevant to both health care providers and consumers; NCML is seeking the assistance of GPs, specialists, health professionals and consumers with an interest in musculoskeletal health to become part of this project and to ensure its success. Symposia are planned for Port Macquarie and Coffs Har-

bor early in February 2015 at a date to be confirmed. Please keep your eyes, ears and diaries open so as to not miss this important event. For further information, contact Project Officers Fiona O’Meara on 0409 613 976 or Martin Cushing on 0418 316 648. Email mcushing@ncml.org.au and fomeara@ncml.org.au

Kalina manager wins Inspired Care award Congratulations to nurse Susan Clark, the Service Manager at Caroona Kalina UnitingCare Ageing (UCA) facility in Goonellabah for winning a national award recognising her leadership of inspired care. The Leadership of Inspired Care award is given to a manager who has demonstrated excellence in leadership, innovation and creativity, is an inspirational role model, has made a significant impact on the lives of older people and has demonstrated commitment to UCA’s mission, vision and values. To demonstrate the compe-

tition for such awards, UCA has about 9,000 employees around the state with 77 aged care residential services and another 10,000 independent living units and community places. Susan received her award at a dinner in Sydney in August. At the event, UCA recognised and honoured its outstanding staff during the Carol Penning Awards night. Carol was a pioneer in person-centred aged care. The awards acknowledge a level of commitment and dedication to clients far beyond that which is expected. The judges said that Susan’s

Award winner: Susan Clark

award was in recognition of the inspirational role she played in moving Caroona

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Kalina “from the better than average facility that it was, to its current position as a leader in the aged care industry”. UCA Director Steve Teulan said on the night that it had been a great experience to watch Susan realise her potential as an able, humble leader. “You encourage and support your people to grow and innovate for the benefit of residents and their families. You are a wonderful role model, Susan, and a very worthy recipient of this important award. We are fortunate to have you as a leader of UnitingCare ageing.”

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The Art of Living Better Last month, HealthSpeak‘s clinical editor Dr Andrew Binns and Arts Health and Wellbeing writer Janis Balodis made a presentation at an international conference about some of the stories featured in the magazine’s Arts section. Janis and Andrew talked about the inextricable link between arts, health and wellbeing, through the prisms of a number of North Coast artists at the International Arts and Health Conference at the National Gallery of Victoria. Andrew, a practising GP in Lismore has had a long passion for the inextricable link between the arts, health and wellbeing and was instrumental in the establishment of the Northern Rivers Arts Health and Wellbeing group. He told the conference that active listening was the most valuable skill a GP could have. “We have found a writer’s version of such case histories has added another dimension leading to a deeper understanding of their suffering and the importance of art practice in their recovery.

We live in a ‘me society’ which threatens social cohesion and community spirit “There is no doubt we are living in rapidly changing and stressful times. Our world seems to be increasingly narcissistic and competitive – a ‘me society’ which threatens social cohesion and community spirit,” he said. Andrew said an impressive antidote to these circumstances was a self-help mental health program developed by Prof Rob Donovan from Curtin University called Act-Belong-Commit (ABC). (http://www.actbelongcommit.org.au/) “This provides a simple framework and guidance for

individuals to become more proactive in maintaining their own mental health and wellbeing, whilst at the same time promoting community engagement and spirit.” 1 ACT: Do something – for example go to a gallery or performance 2 BELONG: Do something with someone – stay connected to friends and family, get involved in a group 3 COMMIT: Do something meaningful – set goals, learn a skill, volunteer, commit to a cause Janis then presented a number of case studies featured in HealthSpeak to demonstrate how effective the ABC approach is in coping with adversity and building resilience, no matter how traumatic the stressors in a person’s life have been. “The eight profiles I’ve written for HealthSpeak in the past two years are mini-case-studies of adaptation, of how individuals and groups have overcome major health setbacks and personal challenges, not only to survive but also to thrive. And the agency for that change in circumstances has been artistic practice,” he told the conference. Among others, Janis spoke about Bundjalung artist Adrian Cameron who had been in every boys’ home in NSW by the time he entered Maitland Gaol at the age of 16. “His early life was an impossibly hectic and chaotic cycle of drug and alcohol-related crime, followed by prison time. It is hardly surprising he suffers from extreme anxiety. Yet at the heart of his paintings is a quiet beauty and sense of peace.”

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Top: Singer Jessica McElroy. Above: Bundjalung artist Adrian Cameron

Janis said that Adrian knows he has to COMMIT to painting. It is the one thing that calms him right down. He says he gets depressed if he can not paint. In the same way, Jessica McElroy’s passion for singing not only gave her physical and moral strength but also possibly saved her life. Janis said that Jessica’s dream of a career as a performer was interrupted by an early pregnancy and birth, both of which she found more physically challenging than she expected. “Jessica knew she had to ACT. She returned to weekly singing lessons, practised regularly, went to the gym, ate well and had a busy working life. Yet over the next five years her health deteriorated. After a heart attack at 28 Jessica was finally diagnosed with a hole in her heart and had corrective surgery.” Jessica has COMMITTED

to rebuilding her strength and stamina and has been invited to join a professional singing group, all sopranos, to bring joy to others. Other stories featured at the conference involved the Casino Community Men’s Shed (which was started by a woman), boilermaker Zip Balodis, Indigenous artist Karla Dickens and Luis Fernando Madrid and the Northern Rivers Youth Orchestra. HealthSpeak looks forward to bringing you more inspirational stories by way of Janis’s pen next year. Andrew and Janis plan to present their talk to medical students in the near future. A feature on this presentation can be heard at: http://www.abc. net.au/radionational/programs/ lifematters/does-art-really-work-astherapy3f/5883038 27

Memories of Flanders By Dr Wes Vickers Holidays seldom tempt me to go abroad, and, true to form, my latest trip overseas was more pilgrimage than holiday. My wife, Bron and I travelled with our daughter and son-in-law from Sydney to Paris via Malaysia and Singapore. After a day or two in Paris, our chaperones left for Malta and Sicily. Bron and I joined a guided tour of the western end of the World War I battlefields. I especially wanted to connect with two battles: Fromelles, the first and worst-managed Australian battle in Europe – some would say the worst day in all the known history of Australia; and Hamel, Australia’s brilliant first battle in World War I to be planned and directed by an Australian commander - the one a seminal disaster, the other a seminal triumph. Les Carlyon’s book The Great War set me thinking. It eventually led me to read more recent literature on the overnight battle near Fromelles in 1916. The action lasted a little over 11 hours, and decades had to pass before the intensity of the struggle was formally recognised as a battle. The location was clearly demarcated in time and place, so it was almost impossible that anyone could have deserted or hidden from the scene; but, somehow, nearly 200 Anzacs, about 7% of the total number sent into the battle, simply disappeared. No-one investigated. The 3300-plus Australians killed that night exceeded the combined total killed in the Boer, Korean, and Vietnam wars, and the death toll is more than for any other 24 hours of continuous fighting before or since. Of course, the cumulative toll of Australian and other ‘English’ troops over the subsequent weeks of engagement in the Somme and other battles was much higher, until the Australian general Monash was given field command of nearly all British troops in France. It seems that, towards the end 28

of the War, Britain allocated any available new troops to Monash, rather than to British generals. The notion of troops as ‘cannon fodder’ had been superseded. In the 1990s a Victorian schoolteacher, Lambis Englezos, was researching a deceased friend of his grandfather. This started Lambis on a painstaking paper trail that lead to the information that the bodies of

opened were firmly rebuffed for several years. Authorities in Paris were a little more flexible, but they would not carry the cost of any subsequent forensic investigations. Eventually the rules changed. First, DNA matching of suitably preserved human teeth against the DNA of appropriate living relatives became feasible. Second, in Bavarian military archives in Munich, a directive,

‘English’ soldiers killed within the Bavarian territory in the Fromelles 1916 battle had been collected by the Bavarians and buried, with due care, behind the lines in a series of pits. Requests from Lambis and his supporters to the relevant authorities in Australia and England to have the pits

hand-written by the general commanding the German troops at the Fromelles battle, was found. It set out the location, size, shape, and number (eight) of pits to be prepared for the burial of all of the ‘English’ troops who had died inside the German precinct during the battle.

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This was no ordinary tour – more akin to a spiritual awakening The general had based his calculation of the required total volume of the pits on the assumption that the maximal number of bodies would not exceed 400. Third, the open and then closed pits had been photographed and dated by English air crews in the days after the battle, but allied authorities took the improbable line that the pits were possibly sites for construction of bases on which heavy artillery guns could be mounted. Fourth, by sheer good luck, it seemed possible that the quality of the soil and underground water and the movement of that water through the burial pits were such that measurable amounts of DNA may still have been present in the teeth of at least some of the victims. The financial cost of the proposed investigation was, probably, the main concern for the bureaucracy that was being pressured to approve the project, but, eventually, a fully equipped forensic investigation was approved, the bodies were found, and most have since been identified. For some of the few who have not been identified, the delay is caused by the inability of investigators to find a descendant with the appropriate pedigree for attempting a DNA match. The unanswered questions now are: By approving the Fromelles investigations, has a precedent been set? If so, how many other sites may have to be similarly processed and at what financial cost?

I particularly wanted to connect with two battles, Fromelles and Hamel The other battle field I was particularly intent on visiting was Hamel (now El Hamel), where, about a year after Fromelles, the diggers, led by John Monash, routed the enemy within 93 minutes of the start of action. This was the first battle in which Monash commanded the whole AIF and sundry other arms, especially aircraft and tanks. But he was a bit disappointed with the result, exceeding his planned completion time by three minutes – no doubt plus or minus his customary leeway of 15 seconds. He relied on tight, detailed planning and strict compliance by his officers with the agreed plan, which required unprecedented integration of artillery, infantry, tanks, and aircraft. Despite resistance from many of his UK peers and a couple of influential Australian non-combatants, promotions

thereafter came to him in quick succession, perhaps not least because he impressed King George V as a general who got results quickly and with minimal loss of men. Unfortunately, Monash did not have the rank to prevent or call off the disastrous Passchendaele debacle, with its uncertain objective, heavy and unrelenting rain, and cold. Some say that the fiasco extended World War I by about a year. Bron discovered that Manly-based Matt McLachlan’s Battlefield Tours offers ten-day bus tours of the most relevant sites. Each tour is guided by one of a panel of well-credentialed historians. Having assumed that the tours for 2015 and 2016 were likely to be heavily booked because of multinational WW1 commemorations, we booked to go this year. At our age, it seemed prudent not to delay such a trip. We found the other nine “battle-fielders” and our guide, Will Davies, in Paris on 14 July. Every one of us had a link to at least one grave there. Will brought the battles to life for us. He lives in Sydney and is a well-known author and editor in this field. (See Google for references.) He was a history advisor to the makers of the film Beneath Hill 60. We crossed paths with Matt McLachlan several times as he was travelling by car while writing a new edition of his Western Front guidebook, Walking with the ANZACS. We were introduced to a number of dignitaries from Australia, (including the Minister for Veterans Affairs), and to Madame Marie-Paule Demassiet - now in her nineties, the former owner of the land in which the pits containing the remains of the lost soldiers were found at Pheasant Wood. And, perhaps best of all, to Lambis,

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who was the first to recognise the discrepancy in the body count from the battle and persistently sought to have the bodies found, identified, and honoured. In 2010 the bodies were re-interred at the Fromelles (Pheasant Wood) Commonwealth War Graves Cemetery. Our group attended an impressive memorial ceremony on 19 July (the anniversary of the battle) for the dedication of the headstones on the graves of 20 newly-identified diggers. Civil and military dignitaries from Australia, Great Britain, and France, and school children from Fromelles and an English school took part. There are a number of books dealing with some parts or other of the story of the diggers at the Western Front. One source that gives essential new facts and perspectives is Peter Barton’s The Lost Legions of Fromelles. Barton went to Germany and found and consulted the original diaries and other official documents written by the Germans who devised and maintained the campaign. Identification of his sources appears to be meticulous. As a result, I doubt if any book written prior to Barton’s will not require substantial revision on several matters. He is currently compiling a website that will carry references to or copies of most of the material used in his project. Most of the Red Cross data has been transferred from Germany to the Australian War Museum. In the course of the tour, we left small wooden crosses on the grave of one of my great uncles at Dartmoor Cemetery at Becordel and on three graves at Fromelles of relatives of two of Bron’s work colleagues at St Columba Anglican School. The Wilson brothers were two young sawmill hands in Port Macquarie prior to volunteering for overseas service, and the third was Percy Geason. This was no ordinary tour by any stretch – more akin to a spiritual awakening. We continue to draw from it an enhanced understanding of the influence of WW1 on our current way of life.

Residential treatment centre opens A five-bed residential treatment centre at Myocum in the hinterland of Byron Bay, opened in October offering a six-week program for clients with a range of conditions. The Nungkari treatment centre came to life through the vision of Clinical Director and psychologist David Godden and Managing Director Kylie Beattie. Their team of therapist and practitioners provides individualised programs for clients, addressing all aspects of their care. David was running a one person facility at Possum Creek and after meeting Kylie they discussed the possibility of opening something bigger. Nungkari, a 3.5 acre centre provides a safe and nurturing environment, far removed from a private hospital setting. Nungkari staff treat the following conditions: Eating disorders Drug and alcohol addiction Depression and anxiety Trauma/PTSD Sex addiction Co-dependency Pain management HealthSpeak visited Nungkari and was impressed with the comfortable accommodation in a rural setting. David explained that clients attending Nungkari require long-term support and the centre offers a supported living

Nungkari Clinical Director David Godden with Managing Director Kylie Beattie

The comfortable lounge area at Nungkari

program after they complete their six-week stay. “It’s called Stepping Stones and operates out of a house in Byron Bay. In my experience behaviour change is one of the most difficult things a person can do, it takes a lot of work, time and commitment. Stepping Stones gives people the support they need to make changes in their life,” he said. Kylie said overcoming addictions took a lot of support and was about surrounding the client with the right types of people. “They need to learn how to navigate out of relationships or environments which aren’t healthy anymore rather than just leaving Nungkari and going it alone.” The role of the family in supporting the person in

the recovery process is also acknowledged with family members invited to join the client during their final week of the recovery program. A range of therapies is available including equine therapy, sound and art therapy, Family Systemic Constellations with addictions counsellor Maria Dolenc, yoga, meditation and psychosocial sessions that include work around managing relationships and boundaries. Clients are also taken on outings – a walk on the beach, to the local markets, kayaking or a visit to a local spa. The health team includes a psychiatrist, a consultant nurse, psychologists, psychotherapist, disordered eating consultant and an equine therapist. David said that Nungkari is

not suitable for clients needing acute mental health care but it could take certain people who are detoxing. A creek runs through the picturesque property and improvements are being made all the time. “Our chef is cultivating a vege garden and clients will grow their own veges, that’s a grounding activity. The bush regeneration team is down there now and preparing the creek side and getting rid of the camphor laurels and the weed. We’re planting species for koalas, we’ve installed solar power and we’re working towards being fully sustainable. It is exciting,” said David. Inquiries to David Godden on 0457 888 890 or email: info@ nungkari treatment.com.au

New GP at Fred’s Place The medical Clinic at Fred’s Place in Tweed Heads, run through a partnership with North Coast Medicare Local and St Vincent de Paul has a new GP. Fred’s Place offers a home and support services for people who are experiencing homelessness or at risk of homelessness. Dr Paul Davies, a highly experienced semi-retired local GP from Davies Beach Medical Centre started working at the clinic in late September. Fred’s Place Service Manager Jason McDonald said that the clinic had been

incredibly successful and has recently moved from a once a month clinic to fortnightly due to the arrival of Dr Davies. “Dr Davies has settled in well and has been well received by the people who access the clinic. The overwhelming success of the clinic is based on people being able to access medical services in an environment that is non-clinical and accepting of the challenges they may be facing,” said Jason. The clinic operates from 1pm to 4pm and provides service to six to eight people

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per session. More than 100 people have attended the clinic since it began. The clinic is also supported by a nurse who is able to perform essential health screening and general nursing duties. Through the clinic people can also access a psychologist. “St Vincent de Paul (Fred’s Place) are very happy and grateful to be involved in this partnership,” Jason added. For more information, phone Jason on 07 5536 1906.

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Fostering competition The Federal Government’s draft Review of Competition Policy released in September has the potential to radically change the Australian economy. If the final recommendations from the committee - chaired by Professor Ian Harper and due in March next year - follow the draft recommendations then we will be in for some tumultuous times. And if the Government decides to adopt the recommendations in total it will probably get a bit ugly. But change is needed. Some sections of Australian industry are protected by cosy arrangements that are championed by powerful vested interests and protected by Government at the expense of the consumer. Others have become bloated and lazy. Still others would benefit from allowing market forces to direct scarce resources to areas where they create the most value. If implemented wisely, the light of vigorous competition can help lower prices and promote greater choice for consumers. But caution is needed. Every change has to be looked at individually with a careful view to see that there are not unintended consequences that could see some sections of society seriously disadvantaged. The Government needs to ensure that market fundamentalism – rife in some sections of government- does not overtake common sense. Otherwise, great damage could be done. Free and unregulated markets do not always work in the best interests of either consumers or society as a whole – witness global warming, the Global Financial crisis, tobacco companies and environmental degradation. They also require a great deal of transparency so consumers know exactly what they are buying. In particular, the Review recommends that restrictions be lifted on retail trading hours, taxis, and pharmacies, the medical and legal professions, health insurance and parallel imports.

Market-based reforms led to a widening gap between rich and poor It wants a user pays system for the road network and recommends that vast areas of government activity be exposed to competition that have never faced competition before. If implemented, it will have a huge impact on the health and social security sector. It also wants greater competi-

tion in all areas of education including schools. The review is wide-ranging and looks at all levels of government – federal, state and local. The Community Pharmacy Agreement, a cosy arrangement between the Government and the Pharmacy Guild of Australia, is clearly in the review’s sights. It recommends that the agreement be changed in two key areas. The current regulations greatly restrict competition by stipulating that only pharmacists can own pharmacies and by rules that restrict the setting up or relocation of pharmacies so they must be located at a minimum distance of at least 1.5 kilometres from existing outlets. Abolishing these rules, which do not apply in other profes-

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sions, could see new pharmacies opening in busy commercial areas and even in supermarkets. Deregulating the taxi industry is another high priority area. Current laws restrict the emergence of new players such as Uber who are able to take advantage of smart phone technology and provide a faster, more economical service to consumers. The review also looked at the higher prices paid by consumers due to parallel import restrictions and intellectual property rights. The professions also rated a mention including the medical, dental and legal fraternities. In the medical area, issues raised

with the review included admission restrictions on new entrants to medical colleges, restrictions on new specialities and the use of nurse practitioners. The review concluded: “While some restrictions are clearly necessary for health, safety or consumer protection, others unduly impede competition.” Without being too specific, the Review favours a change in the way government services are delivered. Basically, it says, governments should stop providing services directly but instead should allow consumers to decide which services they want. This is already occurring to some areas but it could go further. The model favoured by the Review is one where the government sets the basic rules and

Economy David Tomlinson

provides the money directly to patients/clients with an independent regulator to enforce quality standards. Private service providers then compete with each other and consumers then choose which services they want and who will provide them. While this can work well, it is not without problems (eg there may be no private service providers in some areas) and of course it requires greater transparency to allow consumers to make an informed choice. In the UK where this has been introduced, a website provides information to consumers on services offered by individual health professionals, their riskadjusted patient mortality rate and consumer reviews of health services. The review believes health insurance premiums should be deregulated even though the market is dominated by a virtual oligopoly of four big players. The Review also favours allowing health insurers to cover primary care – a move that some believe will mean the end of Medicare as we know it. Critics of the idea say the result will be the end of bulk billing, an upward in move in medical charges and a move to European-style publicly-subsidised universal private medical insurance. In education it wants greater choice of schools – a policy that could lead to greater social segregation - as it has in other countries. Australia could undoubtedly benefit from many of these reforms but only after the broader effects are considered – such as the effect on more vulnerable sections of society, social cohesion and avoiding increased income disparities. There is little doubt that market-based reforms can and have led to a widening gap between rich and poor – a reversal of the trend that existed in the 40 years after WWII.

ISBAR – a useful tool in RACFs Did you know that ISBAR training has been demonstrated to be effective in a health care setting when used in telephone referral education? The BMC Medical Education Journal cites that six months after an ISBAR education session, the acronym was remembered by 59% of people and used by 94% for a clinical telephone referral. ISBAR is well known in Northern NSW Local Health District as the acronym for Introduction, Situation, Background, Assessment Recommendation. In September, North Coast Medicare Local (NCML) in partnership with North Coast TAFE commenced ISBAR workshops in residential aged care facilities (RACFs). They were presented by Sue Barrett, an Aged Care Educator from TAFE with support from NCML Project Officers Diana Anderson (Tweed Valley) and Erin Priest (Grafton). These workshops were designed to teach the most effective communication methods during the exchange of resident information and how to implement this communication strategy within a facility. The benefits of ISBAR include streamlining internal and external communication and also

took it to the top and presented ISBAR to their organisational executive and drafted revised policy and procedure documents to incorporate the ISBAR framework. A number have also run short training sessions with their staff and implemented ISBAR for their telephone calls, handover and referrals to the hospital and GPs. The simplicity of ISBAR means that it can be used for faxes, memos and applied when revising forms such as incident reports or complaints. Sue Barrett, RN Teacher of health in aged care and nursing at TAFE’s Kingscliff campus with NCML’s Diana Anderson at the ISBAR training at Kingscliff.

the fact that it can also be documented as a quality improvement practice in a number of Accreditation Standards areas. Care Managers, Quality Managers, Clinical Educators and team leaders came together representing 45 Residential Age Care Facilities (RACFs) in workshops at Ballina, Casino, Kingscliff and Lismore. Further workshops were held in October in Grafton and again in Kingscliff. In the month after the workshops one participant

Cultural Awareness Training

In early October, NCML’s Mid North Coast Closing the Gap team ran RACGP accredited Cultural Awareness training in Coffs Harbour. A total of 17 GPs and practice staff and nine Medicare Local staff attended the event held at the Novotel Pacific Bay. The training includes learning about the histories of Aboriginal and Torres Strait Islander peoples and how some past government policies have impacted on Indigenous Australians today. It aims to help participants Become aware of Indigenous cultural 32

Oral health forums in Ballina and Coffs

Dr Sally Hibbert, paediatric dental specialist presenting at the Coffs Harbour forum.)

diversity; Become aware of Aboriginal and Torres Strait Islander cultures from a traditional perspective; Look at culturally appropriate models of care using Medicare item numbers Develop skills in effectively asking if people identify as being of Aboriginal and/or Torres Strait Islander descent. To help practices improve the way they work with Aboriginal clients, cultural competence check lists have been drawn up to identify how health professionals can improve working with the Indigenous community. HealthSpeak

During October, oral health forums for oral health professionals were held in Ballina and Coffs Harbour. These events were organised to increase collaboration, mutual support and sharing of learning among oral health professionals. Forum guest speakers included Dr Janet Wallace – Lecturer at the University of Newcastle who spoke about her model of having an oral hygienist available in residential aged care facilities and Karen Sleishman Coordinator Community Aged Care Oral Health Programs from Hunter New England LHD who spoke about the Resi-Dental Program that provides education to RACF staff and also increases oral health treatment for residents. A speaker from NNSWLHD also gave a presentation on a model of care involving dental assistants being trained to work in aged care facilities. In addition, case studies were explored in multidisciplinary groups which allowed for health professionals to interact and work together to come up with solutions.

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Ubud Writers and Readers Festival 2014 It was a laid back affair. It was actionpacked. Centred on the palatial Indus restaurant over an October long weekend, the Ubud Writers and Readers Festival in 2014 was dedicated to Saraswati, the Hindu goddess of knowledge and a shuttle bus fed aspiring writers and their readers to the various events around Bali’s artistic hilltop town. Book lovers travel a long way to join these festivals, to see and hear the great ones for inspiration, to touch them for luck and queue for book signing ceremonies. As evidence of this craving, all the workshops on how to write, such as ‘stretch your story’s potential’ were quickly oversubscribed Another one called ‘Good Script Ratio’ was led by Rolf de Heer, writer, director and producer of acclaimed movies, including Ten Canoes, The Tracker and his most recent production, ‘Charlies Country’. In spite of his warning that ‘a good script is 95% perspiration and 5% inspiration,’ it was impossible to buy or bribe a way in, to learn firsthand his secret card system but that was compensated with an introductory showing of ‘Charlies country’, one of the many free events at the festival. It was there that Rolf spoke openly about his relationship with David Gulpilil, ‘more of a brother than a friend’ who he was happy to report had stopped drinking, sadly though the underlying reason he missed playing in ‘Ten Canoes’. Without wishing to labour the point, while outside Australia, I learned heaps about our indigenous culture from the prominent Aboriginal presence. Maybe it was more relaxed in a neutral country. Elder Clarrie Cameron, an older man with the ambience of an outback stockman gave a very understandable explanation of skin relationships in the Nhanhagardi tribe. ‘If your mother-in-law comes into the

The woman in your life who must be obeyed is the granddaughter room, you just pull your hat over your eyes, but the woman in your life who must be obeyed is the grand-daughter’. There was much more, to which anyone with a family could easily relate. There were lots of opportunities to sit back and be entertained by people from many lands, passionate in their diverse interests. Indonesia was well represented from many angles. A brave young woman from a tiny out of the way island reported through an interpreter how the navy had

Some of the engaging speakers at the palatial Indus restaurant where the festival was held. HealthSpeak A publication of North Coast Medicare Local

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Light Airs David Miller

arrived and dynamited their local reef for a quick fish kill, then left the local people bereft of their sea resources David Leser spoke about his memoir, ‘In the Shadow of My Father’ and explored the area of privileged communication. Every morning his father, a traumatised refugee would retch in the bathroom. He objected to his son’s inclusion of this in the memoir, stating that ‘What happens in the bathroom stays in the bathroom.’ Leser struggled but put it in anyway to keep integrity of story. Doctors considering the memoir about their medical life might reflect on this dilemma around duty of care in confidentiality. The writer I really enjoyed hearing was the imaginative and engaging Amitav Ghosh, in a live radio interview with Michael Cathcart for the ABC. He pointed out that a moviemaker has imagery and music to work with, but a writer “has only words”. He has an impressive line-up of historical fiction, ‘The Glass Palace’, ‘the Hungry Tide’ and I anxiously await release of the final in his trilogy, ‘Sea of poppies’ and ‘River of Smoke’. These fictional accounts bring alive nineteenth century characters, exploring the opium trade. Fortunes made then have been handed down the line to this day, according to the author, a fit looking man with a shock of white hair contrasting his brown face. ‘Historical fiction writing,’ he claimed ‘ is closer to what actually happened than in academic history, more what it was like to live there’. In this vein he spoke of the Lascars, the sailors of the day. It was a generic term, encompassing a multicultural group, a mixture of Malays, Philippine, Chinese and others, who shared a pidgin seafaring language used freely by his characters. He explained how expendable they were in the dangerous business of sailing ships. If a man fell out of the heaving mast into the sea, there was no going back. If he fell onto the deck and broke a leg, he might cast himself overboard, there being no hope of healing or future employment. In his opinion, written language in the nineteenth century was more opaque than now. Surprisingly, He singled out George Orwell as one who introduced rules of written language, aided by a new authority, the Oxford English Dictionary. The ideas presented may be true or fanciful, but always refreshing. Normally a university course is needed for exposure of literary ideas, or a shortcut, the writers festival. 33

Revolutionary walking stick wins award Dr Hilton Beck from Coffs Harbour has won a prestigious Sydney Design Award. He’s been recognised for inventing a revolutionary walking stick – the IQ Stick. The IQ Stick took six years to develop and is a world first with its unique modern design, safety features, appearance and stand-alone ability. Concerned for the safety of patients using walking sticks, Dr Beck designed the IQ Stick to cater for all age groups. The IQ stick rights itself when tapped and can be returned to its upright position, without the need to bend down to retrieve it and also has a glow in the dark feature. It is height adjustable, has a non-slip base, with a stair guard and is made of super strong light-weight materials including

from page 15 breast being better than bottle had got through, but they didn’t know anything about breastfeeding. It wasn’t talked about among women. They also didn’t know many women who had breastfed, but nearly all of them could say what infant formula their friends used, what was written on the formula packets, all of their conversation around feeding was based on formulas. In fact, women were bonding talking about infant formulas. Two other key factors in feeding choices were the affect of the peer group on women’s choices and the huge degree of social disadvantage in Aboriginal communities. “I’ve included case study summaries in the report which really highlight day to day pressures such as housing instability, lack or transport or having to go to court for AVOs or driving offences. All these things impact on every phase of life, including infant feeding. “And it’s like smoking, when you look at how chaotic and challenging these women’s lives sometimes are, you feel a bit ridiculous asking about something as relatively

carbon fibre. The IQ Stick has successfully met all the ISO safety requirements. “The IQ Stick is not only an older person’s walking stick but can assist younger people with sports injuries, those recovering from knee surgery or even hip replacements. “We call it ‘the stick that stands by you’ and I am thrilled to have been acknowledged for creating a living aid that can now help others”, said Dr Beck. Dr Beck’s IQ Stick is only suitable for people weighing 90kg or under and can be purchased on line on the IQStick website or from his surgery in Murdock Street, Coffs Harbour. From left: David Nevell and Dr Hilton Beck.

For more information, phone 6651 9536.

trivial as breastfeeding,” said Catherine. Another big issue for young mothers was breastfeeding in public. None felt comfortable and before having their babies thought they’d be able to cover up and do it privately. The couple who had tried it had awful experiences of being judged and said they wouldn’t’ do it again. In contrast, the breastfeeding champions said they didn’t care where they fed or what other people thought, Catherine said. They had a level of confidence in themselves that allowed them to overcome any common barriers.

Conclusions Catherine’s conclusions were based around professional practice. She found that compassionate and holistic maternity care taking into account the social and cultural lives of Aboriginal women would be most effective in supporting women making their infant feeding choices. “There’s a sense that if people are well educated about breastfeeding and get access to that initial breastfeed with good skin to skin contact and good attachment technique, with good follow up care from a midwife, then that’s

all they need to successfully breastfeed. One of my main conclusions was that that’s not necessarily the case. “Some lives are just too big and challenging and chaotic to be able to continue with breastfeeding.”

Knowledge in community Another key factor in helping turn breastfeeding rates around is the fact that Aboriginal people value and trust knowledge passed onto them from extended family members and within their community. Programs to increase the knowledge base of Aboriginal women in the whole community may have a greater impact on health outcomes than a reliance on health professionals. “The extended family is where their wisdom knowledge comes from, not necessarily what a health professional says,” Catherine told HealthSpeak. This point was demonstrated while Catherine was doing her research. At the same time, the Aboriginal Breastfeeding Association ran a twoday Aboriginal Community mentoring course sponsored by North Coast Medical Local. The aim was for women to become knowledgeable about

HealthSpeak

breastfeeding and to spread that knowledge within the community. “I saw such a difference in how two Aboriginal health care workers I was with spoke about breastfeeding before and after they did the course. “It seems to me that having Aboriginal women as advocates for breastfeeding is a recommendation that all Aboriginal women would agree with. You can’t do a lot about social disadvantage in the short term, but building the whole knowledge base of the community through health workers and Elders would be effective, as women have great respect for what an Elder says to them. Now that her report is complete, Catherine is talking to health workers in Aboriginal Medical Services, and anyone who is interested about her findings. She also presented her report at the International Midwives Conference in Prague. “It was really interesting because midwives from African nations and the Czech Republic told me that some of my findings were of relevance to their work.” You can view a copy of Catherine’s report by emailing her at: Catherine.helps@health. nsw.gov.au

A publication of North Coast Medicare Local

summer 2015

Books with Robin Robin Osborne

How I Rescued My Brain David Roland Scribe $29.99 Medical memoirs continue to impress with their quality with recent stand-outs including Dr Sheri Fink’s harrowing account of the fallout from Hurricane Katrina, Five Days at Memorial; writer-turnedmedico Terrence Holt’s Internal Medicine: A Doctor’s Stories, on US hospital internship; and Christine Montross’s Falling into the Fire: A Psychiatrist’s Encounters with the Mind in Crisis. David Roland’s intriguingly titled How I Rescued My Brain stands apart, not only because he’s Australian but a resident of the NSW Northern Rivers, a psychologist not a doctor (although he holds a doctorate), and has written about his experiences as a recipient of medical care, rather than a deliverer of it. The author’s courage to undertake this task is both praiseworthy and heartening. As the sub-title puts it, he had a “remarkable recovery from stroke and trauma,” a doublewhammy that few will face. Recently, the National Stroke Foundation warned that the

Briefs

Meds for ice addicts Ice addicts could find success in kicking their habit with a new ADHD medication, according to Australian researchers. Similar to the way in which methadone is given to heroin users, an upcoming

trial in Sydney and Newcastle will test the effects of the amphetamine agonist, lisdexamfetamine, as a substitution therapy for ice users. The slow-acting drug holds hope for reducing withdrawal and cravings in ice and methamphetamine addicts, without giving the characteristic high that could foster further addiction.

HealthSpeak A publication of North Coast Medicare Local

summer 2015

number of Australian stroke sufferers would nearly treble to 130,000 in the coming decades. Lamenting the lack of proper support for stroke survivors, and urging the federal government to do better, it listed the nation’s ‘predicted stroke hot spots.’ Second on the list was the NSW north coast. Suffering a stroke is bad enough. Being misdiagnosed is potentially much more dangerous, but so it went at Lismore Base Hospital’s (LBH) emergency department when David Roland was brought in by his partner, in a confused state, clearly ill. “Why are we here?” he recalls asking himself during assessment, “and where is Lismore Hospital? The name is familiar, but it swirls in my mind without a picture. I have an inkling I’ve been here before, though. The memory’s there. On the edge, just out of reach.” The financial stress resulting from the GFC was compounded for Roland by many challenging years spent as a treating psychologist for some of the worst offenders in the prison system. Grafton jail, before closure, was one of his work places. Now he was living with a diagnosis of PTSD. “I’m woolly in the head,” he told ED staff, “as if I’m not sure I’m really here. I’ve got a mild headache, too.” Within hours, discharged and back home, he settles into bed… “My body lets go, muscle by muscle, and sinks into the mattress. Then, the pieces of the puzzle begin to join and a picture emerges. I’ve finally lost it.

Lisdexamfetamine, like dexamphetamine, is indicated for treatment of ADHD in children and was approved by the TGA for that purpose late last year. In an Australian first, researchers will study the drug as a treatment for methamphetamine-dependent people, to determine whether elevated doses of 100–250mg per day are safe.

I’ve had a mental breakdown.” The next day his partner took him to a psychiatric unit where he was admitted as a voluntary patient – “How the hell did I end up here?” - where he struggled to engage with fellow patients, playing his guitar and feeling like a teenager again. After a stint in care, he returned home. Relaxing over a book, he took a phone call and was shocked to learn that a brain MRI had shown the “unfortunate news” of a “mistake”: three weeks earlier he had a stroke. He now realises that his condition is not the result of a mental health issue. So begins the mission to ‘rescue his brain’, a self-directed and assisted quest involving lifestyle changes, medication, research, not least the pioneering work of Norman (The Brain that Changes Itself) Doige, and valuable support from his GP and other local clinicians, including CBT authority Assoc Prof James Bennett-Levy of the University Centre for Rural Health. ‘Recovery’, part 3 of the memoir, is uplifting, although Roland accepts he has not completely recovered, neurologically or psychologically, and for now should not return to clinical work. After a less than nostalgic visit to LBH, he gains access to his hospital records. “I find it puzzling that throughout the notes amnesia is remarked upon, as well as confusion, but in some instances the notes say I was oriented to time and place. “The notes reveal that the medical personnel were aware I had vomited on the way to hospital and that I had a headache. My C-reactive protein count, ascertained from the blood tests, was slightly elevated. “These are all signs, I’ve since learnt, that are consistent with a stroke.” David Roland says he will “continue with writing, public speaking, and advocating for mental-health and disability issues… and with drinking coffee, playing music, being a father, swimming – and investigating my brain.” 35

Academic wins Pharmacist of the Year Lindy Swain from the University Centre for Rural Health North Coast (UCRH) has been awarded the national honour of Pharmacist of the Year by the Pharmaceutical Society of Australia. The award is in recognition of Lindy Swain’s leadership and advocacy in rural pharmacy and Aboriginal Health. Lindy’s academic involvements have included supervising pharmacy students undertaking Aboriginal health and medication tutorials, pharmacy assistant placements for local Aboriginal students at TAFE, and coordinating multidisciplinary placements for pharmacy undergraduates in various clinical settings. She works one day a week at Bullinah Aboriginal Health Service in Ballina where she counsels patients about their medicines and conducts medi-

I am very lucky as I love the work I do

Lindy Swain

cation reviews. “We are proud and delighted that Lindy’s outstanding leadership has been recognised nationally by her pharmacy profession,” said UCRH Director Professor Lesley Barclay. “We benefit greatly from her strong well informed leadership locally, and it is wonderful that others see how this contribution is so significant.” Recently Lindy Swain was

appointed to the board of the National Rural Health Alliance, Australia’s peak non-government organisation for rural and remote health. She joined UCRH Director Professor Lesley Barclay AO, who is the Alliance’s Deputy Chairperson. Lindy Swain said, “It is a huge honour to receive the 2014 Pharmaceutical Society’s Pharmacist of the Year award. Every day many pharmacists do amazing things and make a huge difference to people’s lives. They all deserve awards. “I am very lucky as I love the work I do and am constantly inspired by the students, young pharmacists and Aboriginal patients I meet.”

Comprehensive new cardiac practice in Coffs

The new practice at 40 Mackays Road, Coffs Harbour.

A new cardiology practice has opened in Coffs Harbour with state of the art ultrasound technology that its owners say will benefit not only patients but the environment as well. Mid North Coast Cardiac Services, run by Interventional Cardiologist Dr David Henderson and Clinical Cardiologist Dr Tanya Stewart, is the first 36

practice in regional NSW to install Philips’ Epiq 5 ultrasound machines. Dr Stewart said the paperless aspect of this latest equipment is beneficial to the environment while giving patients a quick and accurate diagnosis. The results are then shared with the general practitioner faster, improving patient care. Mid North Coast Cardiac

Services provide echocardiography, stress testing (including stress echocardiography), pacemaker and defibrillator clinics, Holter monitoring, 24-hour blood pressure monitoring, CT coronary angiography (in conjunction with Coffs Radiology) and consultations with Drs Henderson and Stewart. Cardiac catheterisation and percutaneous intervention is performed by Dr Henderson, the only cardiologist in the region able to perform both coronary angiograms and stents – saving patients from two invasive procedures. Referrals can be made by email, fax, post or Healthlink. Urgent cases can be fast tracked with stress testing results within 48 hours. Mid North Coast Cardiac Services is located at 40 Mackays Road, opposite Baringa Private Hospital in Coffs Harbour. Phone 6652 6928, fax 02 5619 2010 and email info@mnccardiac.com.au Website is at: www. mnccardiac.com.au

HealthSpeak

Adverse reactions – reporting website The Therapeutic Goods Administration (TGA) has launched a web-based service for consumers to report side effects also known as adverse events, associated with medicines and vaccines. It is generally acknowledged that adverse events are under-reported around the world, with estimates that 90-95% of adverse events are not reported to regulators. In recent years evidence has emerged that adverse event reports from consumers contain information that is useful for monitoring the safety of therapeutic products, but there is low consumer awareness about reporting systems Each year the TGA receives more than 17,000 reports of suspected adverse events to medicines and vaccines. In 2013 about 3% of these reports came from consumers, compared with 55% via pharmaceutical companies, 17% from state and territory health departments, 10% from hospitals and hospital pharmacists and the remainder from community pharmacists and general practitioners. The new web-based reporting service for consumers is one initiative the TGA is implementing to encourage reporting among this group. Go the website here: http://www.tga.gov.au/ safety/consumer-sideeffect-report.htm#. VCpBu1cz2PU

A publication of North Coast Medicare Local

summer 2015

Wine and good health Make mine rosé French for rose, a wine by any other name would smell as sweet. And to borrow from a Cindi Lauper song, “rosés just want to have fun”. But that’s not all they offer. Yes, as understated and lightweight as they seem, there is some serious drinking pleasure to be had from a humble glass of the light red wine. The French know how to pack a punch into what is in reality a white wine made from a red grape variety, with a day or two of skin contact thrown in for colour. Interestingly, the grapes used in the better rosés are typically thick skinned, so we have grenache and syrah (shiraz), cabernet sauvignon, cabernet franc and sangiovese all used in various parts of France. I think this is what gives rosé its grip, or tannic edge, as you can’t have colour without tannin. The counterpoint is Beaujolais Nauveau, made from the thin-skinned gamay grape for immediate consumption. Presently there is more rosé than white wine produced and drunk in France in summer, in keeping with their habit of drinking wine with a meal. How well do we fare in the New World? Very well indeed, with a dozen or more good examples being made. I particularly like each of the rosés shown on the back page of Kemeny’s Wine Dominion, with three coming from Oz, two from France and one from Italy. And as with any other wine it is the colour which tells the story. A rosé with good depth of colour will generally have good depth of flavour, and if allowed to flow from the grape gently over the skins will have none of the tannic bitterness found in similarly priced shiraz or cabernet. Some of us may have been brought up on the Portugese version, Mateus

Chris Ingall

Some say pinot noir is rosé on steroids, and in a way they are right Rosé, in the fancy bottle which was then used as candelabra. Much sweeter, it was a wine to guzzle all by itself, rather than trying to match with food, and interestingly has made way for the drier, food friendly

HealthSpeak A publication of North Coast Medicare Local

summer 2015

styles. You will also see the term used in Champagnes and Oz sparkling wines, where the wine can be made by ‘bleeding’ the juice off the must, which concentrates the remaining flavours for a red wine, while the bled juice is fermented as a rosé style within the Champagne. A less used and inferior method is to mix some colour back into a white wine to make it pink. And the real beauty of it? Why, the price of course! They come into their own in a restaurant, where prices of wine are often sadly overinflated (that’s why I like wine bars...the wine is reasonably priced and the food now nearly as good). I looked at a dozen or so better restaurants both locally and in the capital cities, and the rosés were generally half to two thirds of the price of other red wines. They were also perfectly placed within their drinking window, unlike the blockbuster reds which were far too young to properly enjoy. Rosé is a great food wine, especially good with entreés or tapas, as it has enough edge to help digest what are increasingly slightly fatty morsels. The taste spectrum is mineral and fruit mixed, with soft tannins and acid, a perfect match. Rosé should be served slightly chilled, say at 10 to 12 degrees Celsius, to allow some floral aroma to reach you from the glass. Some say pinot noir is rosé on steroids, and in a way they are right. Pinot is the champagne grape which gives it that lovely colour, moving into the salmon spectrum when it is left on the skins. And how beautiful these wines are, often demanding a higher price than the blanc de blancs (chardonnay only) or usual House style. Yes, rosé is a real blessing as we enter the warmer months. Perfect for lunches, with some rosés lower in alcohol....to help you escape the siesta.

Wine Tip When choosing a wine to partner a dish, either in a restaurant or at home, think about what you would add to the dish to flavour it. So lemons with white fish or oysters means choosing a semillon, with its fine lemon core, while a Thai curry marries up with a limey riesling. The sour cherry taste found in the better pinots is a great partner for duck, and a peppery shiraz is a wonderful match for lamb or beef. I think cabernet goes best with veges actually, but that’s just me. And rosé? Any of the foods of Provence go well, their aromatic herbs (Herbs de Provence), olives and garlic making a perfect match. Try it with any tapas.

Cellar Tip Don’t cellar rosé. It is best drunk young, between one to four years old for freshness and verve. It just doesn’t have the structure to age, and quickly loses its appeal. And if you do put some bottles aside by mistake, wrap them up as Christmas presents for the rellos. They look nice, and can be used for vinegar.

Travel An Australian Abroad

Barcelona

By Alex Lewers They say the definition of stupidity is doing the same thing over and over again and expecting different results. As a ‘veteran’ of two airport sleeps now, (and I use the term sleep in the loosest possible way) I can begin to see what they mean. On booking our tickets from Sardinia, Italy to Gerona Airport en route to Barcelona, we decided that an airport sleep would be our best option given our 12:30am arrival time. After touching down we wearily set about looking for a quiet spot to lay our heads (mistake number one). We soon discovered that even at night, getting a quiet spot in a regional airport is near impossible. Instead, we settled for a spot nearby the other airport sleepers and, unwittingly, the airport vending machines (mistake number two). What do 30 people do when they can’t sleep? They get the munchies. Which is fine, unless the only eatery still open at 1am happens to be next to your bed. After six hours feigning sleep on our cold concrete mattress, we made a beeline for the first airport coffee shop to open, bought our bus tickets to Barcelona and waved goodbye to our days of airport sleeping. At least we could be certain of one thing: the only way from here was up, and up it did go. A goal of this trip has been to eat the signature dish of each country we visit at the best restaurants. In Italy, we scoured online articles and blogs in our downtime to discover the most delicious gelato, pizza and pasta. In Barcelona however, we thought we’d save ourselves the trouble and hire a food guide to take us on a tantalizing tapas tour. At each stop, our guide would give us a brief history of the dish (did you know the word tapa means lid and that the eating style is thought to have started as a way to keep fruit fly out of your drink?), as well as a history of the area we 38

Enjoying complimentary wine on the tapas tour

were in. Our tour took us from a local produce shop, to a Michelin star restaurant (where we ate the most delicious lemoncooked salmon with ginger), to a rustic traditional eatery and culminated with a glass of Champagne at a ‘Tiffany’s style’ pastelería. Full and somewhat lightheaded from the complimentary wine at each restaurant, we wandered home content with our introduction to Barcelona. On day two in Barcelona we had one thing in mind…Gaudi. Walking the streets of Barcelona, you’re bound to run into some of Gaudi’s works. The distinct dreamlike style of Gaudi’s architecture makes it unmissable (as do the throngs of people at each location). A walk through Park Guell, a 42-acre park designed by Gaudi, is unlike walking through any other park. It’s both surreal and stunning. From the gingerbread style houses to the stone bridges, everything is stylistically Gaudi, encased by beautiful parkland. However, perhaps the bestknown Gaudi monument is the Sagrada Família. Although still under construction after 132 years, the Sagrada Familia is probably the most spectacular monument I have ever seen. Dripping with detail and immense in scale, the Sagrada Familia is truly mind blowing…and that’s before you go inside. Many locals will tell you that paying the entry fee for the Sagrada Familia is not worth it and that it’s more spectacular

from the outside. Ignore them! While it is spectacular from the outside, walking into the building is like being in a scene from Lord of the Rings and something I will remember for the rest of my life. All too quickly we again had to pick up our packs and head off to the next location of our European journey, vowing to return to Barcelona to see the Sagrada Familia in its completed glory.

the Sagrada Familia is truly mind blowing… and that’s before you go inside

The spectacular Sagrada Família

The surreal and stunning Park Guell

HealthSpeak

A publication of North Coast Medicare Local

summer 2015

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Trivia Which of the Teletubbies shares its name with an Italian river? 2 The Egyptian plover is a North African bird that picks the teeth of which animal? 3 With which country did Japan go to war in 1904? 4 The term ‘bunny boiler’ was derived from Glenn Close’s deranged character in the film Fatal Attraction, true or false? 5 What type of creature is a tuatara? Is it a bird, fish, reptile or insect? 6 Which fashion designer designed the famous conical bra for Madonna? 7 What is the alcoholic ingredient in a Snowball cocktail? 8 What is the name of the pet dog in The Simpsons? 9 In animation, who was captain of the Black Pig? 10 How often is the human stomach lining replaced? Every three days, three months or three years ? 11 Geronimo was chief of which North American Indian tribe? 12 What was Sir Donald Bradman’s batting average? 13 In Cluedo, what colour is the playing piece for Mrs Peacock? 14 The musical West Side Story was based on which Shakespeare play? 15 Who was Superman’s first girlfriend? 16 What does ISBN stand for? 17 What Jane Austen novel has a main character named Fanny Price? 18 Who wrote the book ‘A Brief History of Time’? 19 Which food item takes its name from the French for ‘twice cooked’? 20 How many ‘C’s’ denote the value of a diamond and what are they? 21 In winning his first Golden Globe Award, who thanked every American who had not sued him? 1

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Calling all GP’s & AHP who have an interest in the health of young people: headspace Port Macquarie would love to hear from you. Contact Jenny Sinclair on 02 6588 7300 or jsinclair@each.com.au for an informal discussion.

Urgently seeking GP Lismore Family Planning Service Lismore Family Planning offers specialist reproductive and sexual health services. We offer bulk billed services and are looking for a Medical Practitioner to join our clinic. In addition to the Thursday and Saturday clinics at Lismore, there is an option to work at our Kyogle Outreach clinic every second Friday. You should be registered with the NSW Medical Board with current authority and provider number for NSW, and hold the SH&FPA certificate in Sexual and Reproductive Health.

GP Locum available Dr Mark Rathbone MB, BS, FACRRM is available from Monday 12th January 2015 to Friday 20th February 2015. A VR GP with 30 years’ experience in both group and solo rural general practice and unconditional registration. A Locum since 2005 Mark has worked at practices in Victoria, SA, Qld, NSW and WA. Coastal or inland locations possible. Please phone 0429 979 921 for more information. Or email btlocoums@bigpond.com

Katt McDonald OT & DriverRehab Occupational Therapy and OT Driving Assessments Mobile service from Tweed to Grafton E-mail: kattcooper1975@gmail.com Ph: 0417 913 354 (Previously Kathryn Cooper DriverRehab)

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TRIVIA ANSWER 1. PO (river in northern Italy) The crocodile Russia True A reptile (lizard) Jean-Paul Gaultier Advocaat Santa’s Little Helper Captain Pugwash Three days Apache 99.94

13. Blue 14. Romeo and Juliet 15. Linda Lang (Supergirl’s real identity) 16. International Standard Book Number 17. Mansfield Park 18. Stephen Hawking 19. Biscuit 20. Four – cut, colour, clarit and carat 21. Sacha Baron Cohen

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