Healthspeak Winter 2014

ISSUE 8 winter 2014

HealthSpeak

A publication of North Coast NSW Medicare Local

Healthy North Coast Network Online hub for health page 5 professionals 6

Health care is a team sport

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DVA telemonitoring

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Healthy Minds

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Making sense of the world

Looking over the horizon Vahid Saberi Head Office Suite 6 85 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Vahid Saberi Email: enquiries@ncml.org.au

Chief Executive Officer

Hastings Macleay 53 Lord Street Port Macquarie 2444 Ph: 6583 3600 General Manager: Paul Ward Email: hm@ncml.org.au Mid North Coast Suite 2, Level 1, 92 Harbour Drive Coffs Harbour 2450 Ph: 6651 5774 General Manager: Sandhya Fernandez Email: mnc@ncml.org.au Northern Rivers Tarmons House 20 Dalley Street Lismore 2480 Ph: 6622 4453 General Manager: Chris Clark Email: nr@ncml.org.au Tweed Valley Unit 4, 8 Corporation Circuit Tweed Heads South 2486 Ph: (07) 5523 5501 Acting General Manager: Wendy Pannach Email: tv@ncml.org.au

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

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Some might recall that during the election the future of Medicare Locals was a big topic of discussion - with commitments being solicited and commitments given. Once in office the Government commissioned a review of Medicare Locals

by Professor John Horvath.

The objective was to provide independent advice on all aspects of Medicare Local’s structure, operations and functions, as well as options for future directions.

The release of the review report on 12 May was eclipsed by the discussion on the GP co-payment and other Budget issues. It goes without saying that the review outcomes will have a considerable impact on the future of primary health care in Australia.

Overall, the review validates and endorses the role of MLs as coordinators and facilitators of community-based health care.

It states that “There is a genuine need for an organisation to be charged with improving patient outcomes through working collaboratively with health professionals and services to integrate and facilitate a seamless patient experience.” The Report highlights that “Medicare Locals were a response to …[the] issue of fragmentation and some have been quite successful in integrating care for patients and improving the effectiveness of primary health care services…”. It goes on to note, “whether it is a refocused Medicare Local, or a new organisation, there is unanimous support for an entity to be tasked with working to improve service integration and reduce fragmentation to deliver improved health

outcomes and ensure the health system is more productive.”

This is positive as it has taken a long time for Australia to adopt what many countries with progressive health care systems have implemented – a structure for reducing fragmentation in health care delivery and strengthening out of hospital care.

The Report recommends replacing Medicare Locals with Primary Health Organisations (PHOs). So what will these PHOs do and how are they different from the Medicare Locals?

The Report states that “PHOs, once fully established, would be well placed to facilitate and/or administer a range of Commonwealth funded programs, working with Local Health Networks and other local entities to link up the system.”

I note that Medicare Locals were established to keep people

Over the past two years NCML has worked tirelessly to establish a strong organisation healthy and out of hospital, connect care and improve the fabric of primary health care. Over the past two years NCML has worked tirelessly to establish a strong organisation. In concert with our partners we have worked to re-focus the health system on primary health care and worked towards a health system that works ‘as one’. While we need to do so much more, we have made significant investments in supporting and providing professional development for clinicians, including GPs, to improve the fabric of the primary health care system.

The Report recommends reducing the number of Medicare

Locals/PHOs. It states that, “the exact number of PHOs should be decided following discussions with state and territory governments, to ensure effective alignment with LHNs and other service sectors, and careful consideration of jurisdictional regional variations…”. It also recommends that PHOs should align with Local Health Districts but get bigger. In NSW, the North Coast Medicare Local is the only Medicare Local that sits across two Local Health Districts. The North Coast of NSW is not too small to be inefficient and not too large to be unmanageable. It is just the right size for a primary health network. In addition to aligning with two Local Health Districts, NCML has the same footprint as many State and Federal organisations.

Although a large geographical area, it is a size that enables responsiveness to local needs of its many diverse townships and communities.

So what is the timeframe for establishing these PHOs? We are informed it is the DOH’s intention to have the Primary Health Networks (PHNs) fully operational by 1 July 2015. The closing date for submissions is expected to be December 2014.

This would seem to indicate that tender documents will be out by October or even earlier and the announcement made in the first quarter of 2015. The NCML Board is keen to restructure into a PHN. The Board is of the view that incumbency will assist to establish the PHN on the North Coast quickly at much lower cost and help us to build on the work we have done in the past two years. While we recognise much more needs to be done, we are confident we have the building locks to truly hit our stride, work with our partners and stakeholders to improve patient experience and outcomes and enhance the health of our communities and keep our residents healthy.

HealthSpeak is kindly supported by HealthSpeak

A publication of North Coast Medicare Local

winter 2014

Lifestyle medicine for survivors of cancer This article previously published in GPSpeak online is based on a talk delivered by Dr Andrew Binns at the North Coast Cancer Conference on 29 March 2014. More on the conference on pages 17-19.

Cancer survival is defined as survival from the end of primary treatment to either a recurrence, or if no recurrence until end of life.

In Australia the five -year survival from all cancers increased from 47 per cent in the period 1982-1987 to 66 per cent in 2006-2010. The cancers that had the largest survival gains were prostate and kidney cancer, and non-Hodgkin lymphoma.(1) Since the much heralded declaration of the ‘war against cancer’ in the early 1970s, and

Photo courtesy of Rainbow Dragons Abreast

can reduce the recurrence of primary cancers, improve quality of life and extend the duration of survival. For example, in breast cancer, a 30-40 per cent reduction in the recurrence rate was observed in women who followed weight management and exercised regularly.(4) After active treatment there is

tion is commonly seen following prostate surgery. Osteoporosis and sarcopenia (muscle loss) are significant risk factors. Pain can be chronic and cardiac and pulmonary complications can occur.

There is a significant overlap between the risk factors for many types of cancer and those

a need to detect recurrence and/ or new cancers, the later effects of primary treatment, to prevent future cancers and to treat co-morbidities. As regards the effects of primary treatment the stand-out concerns for patients are fatigue, ongoing fear of recurrence, anxiety, depression and insomnia.

There are also body image concerns, for example after mastectomy. Also erectile dysfunc-

HealthSpeak A publication of North Coast Medicare Local

course supermarkets, despite the many less healthy temptations.

Traditional food choices, such as Mediterranean, Asian, Aboriginal or Nordic, are recommended. Be mindful of portion sizes. Limit drinks with high sugar and caffeine content, and watch alcohol consumption.

Physical inactivity leads to loss of lean body mass (sarcopenia), increased fat mass, particularly around the waist (central and visceral), but it can also infiltrate muscle (marbling). There is often associated increased osteopenia and osteoporosis, reduced VO2 max (lower fitness level), and increased insulin resistance, leading to impaired sugar metabolism.

So what sort of exercise is good for cancer survivors? As with everyone the emphasis should be on aerobic exercise and resistance training. If lower limb mobility is impaired, upper body exercise is an alternative as Paralympians have clearly shown us.

A question often asked by breast cancer survivors is whether resistance training increases the risk of lymphoedema?

A study(4) has found this not to be the case, and there is the added benefit of increased strength and functioning. Now popular amongst breast cancer survivors is the sport of dragon boat racing, which helps women Continued next page

Ontario Chronic Disease Prevention Report 2006

the ensuing advances in early detection and molecular understanding of biology of cancer and treatment, there has been a steadily growing number of cancer survivors.(2) Lifestyle medicine is defined as the application of environmental, behavioural, medical and motivational principles to the management of behaviour-related health problems in a clinical setting.(3) Lifestyle management

Opinion Andrew Binns

winter 2014

for other chronic diseases. Lifestyle choices such as smoking, unhealthy eating, inactivity, obesity, alcohol and illicit substance abuse all have proven links with chronic disease. These complex connections are illustrated in the diagram seen below.

Healthy eating tips should avoid specific dieting. Far better is to advocate more natural, less processed food that can be found in our farmer’s markets, or of

Rainbow Dragons Abreast Contact Veda Dorrough Mobile 0428 223 275 Breast cancer survivors and their supporters are welcome to join this group, which is part of the Rainbow Region Dragon Boat Club.

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Communities hungry for more first aid training As you would have read in HealthSpeak’s last issue, North Coast Medicare Local (NCML) is providing a first aid training program – First Aid in Aboriginal communities – across the North Coast through Aboriginal Land Councils.

Gugin Gudduba Aboriginal Land Council, based at Kyogle, was one of the first to take part.

HealthSpeak asked one of the participants, Gugin Gudduba CEO Ron Randall his impressions of the course.

“It was absolutely brilliant.

Mike Johnston, the trainer has extensive experience and Aboriginal people always appreciate learning from someone with experience, we aren’t interested in learning from someone just out of uni.

“Mike really made the material come alive with songs such as ‘Staying Alive’ during the CPR training and ‘Another One Bites the Dust’. Above all, he made learning first aid fun,” said Ron with a smile.

Ron said Mike covered a huge amount of material in one day, but everyone enjoyed it and got a lot out of it.

“They’ve got the confidence and skills to go back to their communities and help out when an emergency comes up. Some-

From previous page physically as well as emotionally as they group together in teams.(5) To address all risk factors GPs are well placed to assist cancer survivors through the Medicare systems for managing people with chronic disease. A targeted care plan and engagement of appropriate allied health practitioners can make a big difference in patients’ quality of life and longevity.

As cancer survivors often have other chronic diseases, a lifestyle medicine approach for their cancer will also be of benefit with helping manage the co-morbidities.

Care plans can ensure that the vitally important cancer

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Mike really made the material come alive with songs such as ‘Staying Alive’.

NCML’s Sandi Hill with Ron Randall, CEO of Gugin Gudduba Aboriginal Land Council in the council’s Kyogle office.

times it can take time for medical help to arrive, so it’s important for community members to be able to respond when things happen,” Ron told HealthSpeak.

Particularly helpful, in Ron’s opinion, was the section on recognising symptoms of diabetes, a condition which affects so many in the Aboriginal community.

A diabetic himself, he understands the value of knowing about type 2 diabetes and getting checked out by a GP if you suspect you might have it. Ron manages his diabetes through education and healthy eating and he’d like to see a program in Kyogle teaching healthy eating

specialist follow-up is also adhered to. A team approach to encourage a healthy lifestyle, along with appropriate specialist care, will offer the best survival prospects and quality of life outcomes for cancer survivors.

(1) Cancer Survival and Prevalence in Australia – period estimates. AIHW 2012 (2) Siegel R, Naishadham D, Jemel A. CA Cancer statistics, 2012 Cancer J Clin; 62:10-29 (3) Egger,Binns,Rossner ‘Lifestyle Medicine’ McGraw Hill (2nd Edition) 2012 (4) Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis:meta-analysis of published studies. Med.Oncol. 2011; 753-765 (5) Kathryn Schmitz: JAMA Dec 2010, Weight Lifting for Women at Risk for Breast Cancer Related Lymphedema RCT

and how to cook healthy recipes held at Gugin Gudduba.

Of the eight participants in the first aid course, seven would like regular and further first aid training – a great endorsement for the new scheme. And down in Coffs Harbour a first aid training participant was chuffed that he

was recently able to make use of his new found skills.

In his presence a client fell to the ground shaking. While a co-worker thought the client was having a stroke, the first aid trained man assessed the client as having a seizure and was able to provide first aid while the coworker called an ambulance.

NCML Program Officer, Vulnerable and Disadvantaged Communities, Sandi Hill, said NCML would also be facilitating mental health first aid training for North Coast Aboriginal communities.

Directors sought for new Allied Health Association The North Coast Allied Health Association (NCAHA) is seeking to appoint five Directors to serve on the initial governing Board.

The NCAHA region covers the area from Tweed Heads in the north, to Port Macquarie in the south and west to the Great Dividing Range.

The NCAHA will focus on supporting the allied health sector and improving the health of North Coast NSW residents. It will operate as a health promotion charity and will work to make health care delivery easier through health system reform.

NCML’s CEO Vahid Saberi, who has supported the establishment of NCAHA, said the proposal for establishing the Association was firmed up as a result of consultation with allied health clinicians.

“This new organisation will contribute to health planning

HealthSpeak

in the region, and will provide a single point of communication with allied health professionals, advance allied health practice and enhance educational opportunities.”

“NCAHA will also work to improve liaison between allied health and other areas of the North Coast health care system, as well as collaborating and communicating with other relevant regional organisations,” Mr Saberi added.

NCAHA is inviting applications from allied health practitioners interested in becoming a Director of the new Association.

For details on eligibility and an application form, visit www.ncaha.org.au/recruitment-of-directors Applications close 5pm on Friday June 27. For more information, contact Shay Jaber on 6618 5429.

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winter 2014

New online network for health professionals Collaboration and knowledge sharing across the North Coast has just become a lot easier for health professionals thanks to Healthy North Coast’s new free online networking platform.

The Healthy North Coast Network is the first of its kind on the North Coast and hosts over 130 regional and craft specific health professional networks including general practice, aged care, medical specialist, pharmacy and allied health.

North Coast Medicare Local’s Clinical Adviser Dr Dan Ewald said the Network would greatly assist in reducing professional isolation and promoting interdisciplinary networking.

“The great thing about the Healthy North Coast Network is that health professionals can converse and collaborate on projects with colleagues without leaving their office.”

“For the first time in our region, health professionals can replace more cumbersome email lists with real time collaboration.”

Dr Ewald said online collaboration was the way of the future, especially in large regions like the North Coast with a scattred population.

The Healthy North Coast Network is based around the functionality of other social networking platforms like Facebook, LinkedIn and Twitter, while providing a more private

Health Minister’s visit

From left: Federal Health Minister Peter Dutton, Vahid Saberi, Chris Crawford and Kevin Hogan.

The Federal Minister for Health, the Hon Peter Dutton MP, visited Lismore on April 9. The visit was organised by the Federal Member for Page Kevin Hogan. Minister Dutton met with the health leadership including Chris Crawford, Chief Executive of Northern NSW Local Health District; Dr Tony Lembke, Chair of North Coast Medicare Local, Professor Lesley Barclay, Director University Centre for Rural Health and a member of the NCML Board;

and North Coast Medicare Local CEO Vahid Saberi.

The discussion highlighted the collaborative work being undertaken by health organisations in Northern NSW and was well received by the Minister who emphasised that integration of care and reducing fragmentation of services as important priorities. The Minister was presented with two documents (i)a snapshot of NCML activities and (ii) The Northern NSW Health Integration Strategy.

HealthSpeak A publication of North Coast Medicare Local

winter 2014

and professional space for health practitioners in which to work.

The site contains functional advantages including a central and accessible document repository as well as a dedicated calendar for health professionals to list their events.

North Coast GP and North Coast Medicare Local Chair Tony Lembke said he was excited about the new platform.

“The Healthy North Coast Network is a ‘space’ where we can easily share information and resources with our colleagues.

“It breaks down professional isolation locally and across the region by allowing medical

specialists to come together with other medical specialists, GPs with other GPs, allied health providers with other allied health providers.

“More importantly, it also creates ‘Communities of Practice’ that bring together our different crafts as one clinical community to discuss issues of importance to us all,” Dr Lembke said.

Health professionals can register for the Healthy North Coast Network by visiting www.healthynorthcoast.org. au/dashboard/signup with full instructions for the platform at www.healthynorthcoast.org.au/ practitioner-resources.

Changes to GP training A number of measures were announced in the recent Federal Budget that will have implications for GP training both locally and nationwide.

The governing body for Australian GP training, General Practice Education and Training (GPET), will be closed and its functions transferred to the Department of Health by 1 January 2015. The Government has also signalled its intention to wind up funding for the current 17 GPET-funded regional training providers at the end of December 2015.

This includes Ballina-based regional training provider, North Coast GP Training.

The Government will run a competitive tender process during 2015 with a view to establishing a new network of training providers in 2016.

CEO of NCGPT, John Langill, believes that in the immediate term there will be no fundamental changes to how the Australian General Practice Training (AGPT) program is delivered and wants to assure all NCGPT registrars, supervisors and practice managers that the organisation will continue to provide the same level of support and training that they have become accustomed to.

Mr Langill is also confident that the organisation will

NCGPT CEO John Langill

be part of any GP training restructure. “Over the last 11 years, NCGPT, in partnership with our network of over 60 dedicated training practices and 150 GP supervisors, has established an enviable reputation as a leading provider of rural GP training. We look forward to continuing our strong relationship with our practices, supervisors and our other regional partners to bring that success to bear in the proposed tender process.”

It was also announced in the Budget that the Prevocational General Practice Placement Program (PGPPP) would cease at the end of 2014. The upshot of the announcement is that the savings realised will be redirected to support further expansion of the AGPT program. Three hundred additional registrar training Continued page 7 5

Health care is a team sport

By Tony Lembke Chair, North Coast Medicare Local

There is no doubt that an effective, equitable and sustainable health system is built by investing in general practice and primary care.

For the price of just one hospital admission, the government could purchase 13 years’ worth of general practice care. In other words, it would be cheaper to pay for someone to see their GP every week for a year then it would be for them to be admitted to hospital for just one day.

The recent Horvath review of Medicare Locals reaffirmed the need for regionally based primary health organisations that focus on integration, quality and access. The review calls for a strengthening of the role of these organisations, and calls for the creation of new ‘Primary Health Networks’ (PHNs).

The size and structure of these PHNs is yet to be determined.

North Coast Medicare Local (NCML) trusts that they will be of a size that allows local solutions to local problems, and that will build on the experience, relationships, people and resources that have been developed by the NCML over the last two years, and in the preceding 15 years as Divisions of General Practice.

NCML aims to support all providers of health care in our region. I’m very pleased that this

issue of HealthSpeak launches the Healthy North Coast Network. This online platform allows all health professionals to join a conversation with their peers and colleagues locally and across the region. It was built in response to the winners of our first PITCH (Practical Ideas to Change Health). The network gives us the chance to ‘share generously and steal shamelessly!’ I encourage you to sign up at http://healthynorthcoast.org.au.

We will increasingly use the Healthy North Coast Network to provide news about events, opportunities and activities.

In addition to this online platform we are continuing the process of bringing people together to discuss issues of importance.

The North Coast Allied Health Association has been established, and a forum has been held for dentists and others delivering oral care.

This month we will bring together medical specialists to

determine what support they need. And we will have meetings with GPs in many of the towns across the region to get their advice on achieving 'integrated care’ with their local hospitals, and other issues of importance.

The Healthy North Coast Practitioner Newsletter was launched this week. It is an online-only publication that extends the capacity of HealthSpeak to provide updated news and information about upcoming events, and consolidates much of the material they you may have previously received from us.

We encourage you to use the online platform and participate in the opportunities to meet face-to-face. We are very keen for you to join the conversation about improving the care we deliver to our communities.

You can contact me anytime on the Healthy North Coast Network. Please send me a friend request. At this point, I only have two. :-(

NewAccess making a difference Since launching in February this year, New Access, a free mental health service for people with mild to moderate anxiety and depression, has seen 125 clients on the North Coast.

NewAccess is a beyondblue program made possible with funds from The Movember Foundation and beyondblue.

NewAccess on the North Coast is a partnership between beyondblue, North Coast Medicare Local, Flinders University and The Movember Foundation. beyondblue’s Chief Executive Officer Georgie Harman said the program was open to anyone living between Port Macquarie and the Queensland border.

“Because NewAccess is a free program and can be accessed through self-referral or via referral channels such as GPs, making accessing support to overcome mild depression

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NCML’s CEO Vahid Saberi at the New Access launch in Coffs Harbour on May 2.

or anxiety much easier.

“We believe its practical approach will appeal to Aussie blokes and see positive results for many,” said Ms Harman.

Depression and anxiety are the most common mental health conditions in Australia, affecting around three million Australians. Anyone from any walk of life can be affected by depression and anxiety and

the risk of suicide increases when someone lives with these conditions.

However, fewer than half of those with a mental health condition in Australia access appropriate treatment. Worryingly, men are less likely than women to seek treatment.

NewAccess is an important complement to existing mental health services.

HealthSpeak

Based on the successful UK program, Improving Access to Psychological Therapies, trained Access Coaches use guided self-help strategies to support people over the phone or in face-to-face meetings.

NCML’s Manager, Mental Health Clinical Streams, Wendy Pannach, said that NewAccess provides people with an easy way to access and receive support.

“The program is specifically designed to encourage people to take action early before their mental health condition becomes severe,” she said.

NewAccess is a free and confidential service to support people in tackling day-to-day pressures. Coaches are located across the North Coast in major towns as well as in Maclean, Yamba, Kyogle, Kempsey and Nambucca. To take action and get back on track, call a NewAccess Coach on 1300 137 934.

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Community party for headspace A community party was thrown for the official opening of headspace Lismore on Thursday April 10.

The previous day, the Federal Health Minister Peter Dutton paid a visit to headspace late in the afternoon and cut up a lurid but delicious green cake for staff and consortium representatives.

Mr Dutton was accompanied by the Federal MP for Page, Kevin Hogan, and both were given a tour of the building.

The Minister said he was pleased that a headspace centre was now available to the youth of Lismore and acknowledged the important work headspace carried out in youth mental health services.

Headspace manager Katrina Alexander told the gathering that since it opened 10 weeks earlier, headspace Lismore had been getting up to 10 referrals a week for mental health assistance.

Before HealthSpeak went to print, headspace Lismore had seen 125 clients (32 per cent

From page 5 places will be available in 2015 taking the total from 1,200 to 1,500 across Australia.

To support the growing demand for extra places, the Government has also announced an additional $52.5 million in infrastructure grants will be available to enable GP practices to build the facilities they need to take on more train-

The opening ceremony crowd.

male, 16 per cent Aboriginal and Torres Strait Islander clients and 24 per cent non-heterosexual.

Katrina said that most clients were aged between 15 and 17.

At the Thursday event, which started at 4pm, Kevin Hogan and the former Federal Member for Page, Janelle Saffin (who worked hard to ensure funding for the Lismore headspace) cut the ribbon marking the official opening

ees. A minimum of 175 infrastructure grants, each capped at $300,000 will be provided.

With additional training places allocated to NCGPT for next year, they are keen to hear from appropriate practices and doctors interested in becoming accredited GP Training practices and GP Supervisors. To find out more, contact Sue Sladden on 6681 5711.

of headspace Lismore. The ribbon cutting was witnessed by a crowd of headspace and NCML staff, consortium representatives and members of the community.

Especially impressive were the young people who spoke – MC Jake Collins and Harry Gregg from the Youth Consultative Group.

Harry spoke eloquently on the benefits to youth of a headspace centre, prompting an onlooker to comment that Harry had a bright future.

NCML CEO Vahid Saberi thanked headspace administration manager Lisa Hampson and NCML Executive Michael Carter in particular for their hard work in getting headspace up and running - transforming a derelict building into a vibrant and welcoming youth hub in a short space of time.

He also commended headspace staff for their commitment and enthusiasm to the centre.

Outside, in the car park there

The Federal Health Minister Peter Dutton cuts cake for staff and headspace consortium representatives during his visit on April 9.

Outside the party was in full swing with a variety of performances. was a party in full swing with a variety of performances. These included an Indigenous female dance group Deadly Doobs from Kadina High, and fantastic music from Mr Speaker and the People Party and the Funk Band from Trinity High School.

The Lismore Lions provided a sausage sizzle and there was even a skateboard demonstration from Brisbane experts the Drawing Boards.

Contact headspace Lismore on 6625 0200.

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HealthPathways is now live!

at fryan@ncml.org.au or phone Fiona on 6583 3600. http://manc.healthpathways. org.au

New to HealthPathways HealthPathways is an initiative of North Coast Medicare Local and the Mid North Coast Local Health District. It’s aiming to be a one-stop shop for accessing local health information online.

The Mid and North Coast HealthPathways website was set up to allow health practitioners to assess and manage a wide range of medical conditions with evidence-based best practice.

Launching with hundreds of topics developed for Canterbury New Zealand and a growing pool of locally developed and adapted topics, each localised pathway topic has been put together to locally agreed and improved models of care.

The main focus is assessment, management and appropriate referral from primary care to secondary care.

The HealthPathways website went ‘live’ on 31 March 2014 with 13 localised pathways avail-

able. Within the first two weeks of the site going ‘live’ there were 274 visitors to the site with 2,490 pages accessed.

The top five pathways viewed in this period were: Persistent Non Cancer Pain, Improving Milk Supply, Bell’s Palsy, Opioid Use in Persistent Pain and Diabetic Eye Disease Screening.

Other topics being drawn up by workgroups include: Paediatric, Pain, Antenatal Care, Hospital in the Home, Musculoskeletal topics, Respiratory and Drug and Alcohol topics, Mental Health and Gynaecology and Diabetes topics.

Through re-thinking how a given condition is managed locally, groups of clinicians and health service managers are leading health system reform piece by piece. It is expected to lead to better care in the GP setting, better access to specialist care, more appropriate use of allied health care, and better patient

experiences.

HealthPathways are published on an on-line information password-protected portal to be used at the point of care for GPs but it is also available to specialists, nurses and allied health providers.

The portal can be found at at: http://manc.healthpathways. org.au Please contact Tracy Baker at tbaker@ncml.org.au for the password.

If you would like to be involved in a workgroup or put forward a pathway to be localised, contact Fiona Ryan, Project Officer, Health Pathways

Persistent non cancer pain (Port Macquarie Chronic Pain Clinic) Issuing a death certificate Development Milestones Postherpetic Neuralgia Emergency Contraceptive Bell’s Palsy Opioid Use in Persistent Pain Gastroenteritis in Children Eye Disease Screening Improving Milk Supply Super Vein Thrombosis Infective Endocarditis Prophylaxis

Program to help stem teenage pregnancy North Coast Medicare Local, in partnership with NNSW LHD and Youth and Family Education Resources, has trained 37 women to run the Core of Life program in North Coast schools and communities.

HealthSpeak attended the training day in Ballina and was impressed by the excitement around this program which will be rolled out in schools and Aboriginal communities.

Core of Life Coordinator Tristan Charles said those trained will now go out into schools, presenting three-hour workshops.

“The presenters will be in pairs with one person having a health background and the other a community role. The workshops will be presented to Year 9 and 10 students,” said Tristan.

The first workshop was at Southern Cross High School at East Ballina. They will be given a second follow up session in 8

The training group. Front left: Elli Saberi, Women's and Child Health Program Coordinator. NCNSW LHD; Emma Walke, Senior Aboriginal Program officer, NCML; Youth and Family Education Resources Core of Life program director Deb Patrick; NCML’s Core of Life Coordinator Tristan Charles and Core of Life instructor Annette Loadsman-Hucks.

November.

Tristan will now organise those trained to commit to presentations.

Core of Life will next be rolled out on the Mid North Coast in August. Word has already spread about the two-day training and HealthSpeak

most of the training places have already been taken up.

Organisations represented in the Core of Life Training include North Coast Medicare Local, NCNSW Local Health District, Ballina High School, Young Parents Program, Southern Cross Distance Education, Jubullum Local Aboriginal Lands Council; Woodenbong Central School; Maari Ma Health Service; AMIHS; Grafton Community Health; Grafton Base Maternity; Kyogle Memorial Health Community Health; Kyogle High School; Youth Connections Norh Coast; Women’s Health; Lismore Community Health; Lismore Base Hospital’s Women’s Care Unit; Department of Education and Communities; NCNSW LHD’s Child and Family Health; The Tweed Hospital Community Health; Far North Coast Family Referral Service and Interrelate.

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General practices: Last chance to take part in Veterans’ Telemonitoring trial Limited places are still available on the in-Home Telemonitoring for Veterans Trial for North Coast practices in Coffs Harbour and Tweed Heads. Interested practices should contact the Department of Veterans’ Affairs (DVA) as soon as possible as places on the Trial will close soon.

Practices already on the Trial are encouraged to submit outstanding veteran consents as soon as possible to secure their patients place on the Trial (DVA fax 02 6289 4727). The sooner a veteran can commence on the trial the greater the health benefits to them, and the longer period of time for evidence to be collected to support robust Trial evaluation.

The Trial is an enhancement to the Coordinated Veterans Care (CVC) Program – a team based program that provides ongoing planned and coordinated care to eligible DVA Gold Card holders.

The Trial enables eligible CVC

Veteran patients are enjoying positive outcomes from the Telemonitoring Trial. participants with congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease or diabetes to measure their vital signs in the comfort of their own home. The Trial will allow the veterans’ GP and nurse coordinator to remotely monitor their readings and be consulted by videoconference where appropriate.

Through North Coast Medicare Local (NCML), 28 general practices on the Northern Rivers and Mid North Coast are taking

Promote your health event through NCML As a result of the large number of requests for North Coast Medicare Local to help promote health events in our region, we have set up a ‘do it To promote your event, simply go to yourself’ system so that organisers the Healthy North Coast website: can post events on our Healthy North healthynorthcoast.org.au/dashboard/ Coast website. signup/ Both events for health practitioners and events for community members Once you register, you can post event information quickly and easily. may be posted.

DVA Gold Card hodlers with congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease or diabetes will have access to teleconferencing and remote monitoring of their vital signs by their general practice. Image supplied, © Tunstall Healthcare.

part in the Trial. Across Australia, more than 50 medical practices have signed up to the Trial across Australia.

DVA would like to acknowledge Goonellabah Medical Centre for hosting a forum earlier in the year about the Trial. Dr David Guest from Goonellabah Medical Centre is an enthusiastic supporter of the Telemonitoring Trial and is coordinating an email network for medical practices taking part, to share their experiences.

The next forum for those approved to take part in the trial will be on Tuesday June 11.

NCML Practice and Liaison

SLEEP CLINIC AYS OPEN D

FREE consultation

Officer Donna Griffiths also organised forums about the trial and made visits to general practices from Tweed Heads down to Nambucca to offer them the opportunity to take part.

DVA encourages patients not on the Trial to consider their Gold Card holder patients who may be suitable for the CVC Program. For more information about the CVC program please visit www.dva.gov.au/cvc.htm For more information about the Trial, visit: www.dva.gov.au/tm.htm or telephone Tracey Noble on 02 6289 4864 or email healthinnovation@ dva.gov.au

What would you do for

A GOOD NIGHT’S

SLEEP?

Phone for more information and ask about our next FREE education day.

Have your questions answered, CPAP problems solved, receive support • Do you suffer from daytime sleepiness?

• Do you snore?

• Are you thinking about a sleep study soon?

• Are you currently on CPAP? Come in and find out about:

IMPORTANT NOTICE Please be advised that No Doctors at this practice are associated in any way with the recent media reports of assault charges by a Doctor from a Gordon Street Practice.

CMC Coastal Medical Clinic

PH 6621 4440 13 Casino St, South Lismore in association with Southside Pharmacy

Suite 1,19 Gordon St, Coffs Harbour

(opposite Dick Smith Electronics, next to Dominos Pizzas)

HealthSpeak A publication of North Coast Medicare Local

Your health is our total concern

- Sleep hygiene – What is it?

- Obstructive Sleep Apnoea - DVD - CPAP therapy - problems solved - Sleep studies - what is involved - Specialist in Fisher & Paykel and Respironics Sleep Apnoea Equipment

winter 2014

9

Healthy Minds program takes off A total of 24 community service organisations from the Queensland border down to Port Macquarie have been successful in their expressions of interest in providing mental health services to vulnerable people through North Coast Medicare Local’s Healthy Minds program.

Healthy Minds aims to overcome the barriers that prevent vulnerable people in our communities from accessing the best quality psychological support for a range of common, mild to moderately severe emotional and behavioural difficulties.

These include depression, anxiety, substance misuses and eating disorders.

Organisations that provide services to people at risk of homelessness, those in financial hardship, children and Aboriginal and/or Torres Strait Islander people were particularly encouraged to apply.

NCML’s Mental Health

Clinical Stream Manager, Wendy Pannach said that through Healthy Minds these organisations will have access to a mental health professional to deliver between six and 12 sessions per client at the community service organisation’s premises.

“We were delighted that more than 120 mental health practitioners expressed interest in working for the program,” she said.

Each organisation signs an MOU with NCML which includes details such as frequency of services, referral and appointment setting processes, space, equipment and administrative support arrangements. The most important benefit is that each organisation commits to supporting their clients to see a GP in order to address their physical and mental health outcomes.

The roll out of Healthy Minds is continuing across the North Coast. A central intake officer receives referrals from GPs with Healthy Minds staff supporting

Child-centered Paediatric Occupational Therapy in Port Macquarie providing: Handwriting assessment & intervention Anxiety management program Gross & fine motor assessment & intervention Bilateral coordination assessment & intervention Self care intervention such as dressing & organisation School readiness and social skills training Call or email now 0407 652 472 erikastevenson0@gmail.com www.superkidsot.com.au 10

From left: Michael Edmondson, psychologist; Nattallee Allan, mental health nurse; and Nicole Julien,Manager, Family Services, Family Centre, Tweed Heads.

communication between the organisation, the mental health practitioner and the GP. While it’s still early days, initial observations are that Healthy Minds has doubled the number of access points for psychological services across the region.

Wendy said that other benefits provided through Healthy Minds were an increased rate of bulk-billed services for disadvantage groups, reduced costs in delivering psychological services; a single point of access for referrers and better access for clients with many no longer having to travel far to see a mental health practitioner.

Nicole Julien is a manager at The Family Centre in the Tweed where NCML has organised for a mental health nurse and a psychologist to provide services at the centre, and she describes Healthy Minds as ‘fantastic’.

“This model has been running for less than four months and the uptake by staff to make referrals has been immediate. It is an amazing complementary service to our organisation.

“Having clinicians on site to provide therapeutic intervention is leading to an amazing outcome for clients. The feedback from clients is very positive to brilliant,” Nicole said.

One Healthy Minds client from Cabarita Playgroup, Suzie (not her real name) said seeing mental health nurse Nattalee HealthSpeak

Seeing Nattalee was life changing for me.

Allan had changed her life.

“I’ve suffered with anxiety since my early 20s and am now feeling so good. I’ve tried other interventions in the past, but seeing Nattalee was different and life changing for me,” she said.

Organisations taking part in the Healthy Minds service include Foundations Care at Coffs Harbour, Tweed Heads and Ballina; NORTEC in Grafton, Lismore and Ballina; Bullinah Aboriginal Health Service in Ballina; Heartfelt House at Wollongbar; Casino Family Support Service; Early Childhood Intervention Program at Coffs Harbour; New Horizons at Tweed Heads; The Family Centre at Tweed Heads and Pottsville; Domestic and Family Violence Specialist Service at Port Macquarie and YP Space at Kempsey.

Clients must have a referral from a GP in order to access Healthy Minds services and must have a Health Care card or be in severe financial distress.

For more information contact Wendy Pannach on 1300 137 237.

A publication of North Coast Medicare Local

winter 2014

Let’s Talk About Sex Talking about sex and sexual health can sometimes be embarrassing especially for young people - however, it’s a conversation that needs to be had.

In April, the Positive Adolescent Sexual Health (PASH) Consortium joined forces with local young people to try and break down taboos around sexual health by putting on the North Coast Regional Sexual Health Conference.

Attended by over 400 people, including youth, teachers, parents, health and youth workers from the North Coast, the event featured an extensive and engaging program of workshops, talks, multimedia and arts based performances.

Regional HARP Health Promotion Coordinator and PASH 2014 organiser Franklin JohnLeader said the event was established help young people develop healthy behaviours around issues of sex, sexuality, sexual health,

body image, bullying, homophobia, consent and healthy sexual boundaries.

“PASH 2014 was a great opportunity for youth participants to engage in open dialogue with their peers and adults around sexual health in a comfortable environment,” Mr John-Leader said.

“Those who attended were able to build skills, resilience and learn about local services which can support them to manage their sexual health and well-being.”

Chair of the Byron Youth Council and conference attendee Aquila Van-Keuk said for her PASH 2014 was all about creating positive spaces where talking about sex and sexual health is normal and fun, and where everyone’s body, sexual values and sexual readiness is respected.

Ms Van Keuk said that sex was a normal part of everyone’s life and that through starting a healthy conversation we could begin to break down the taboos

that surround it.

The two day event culminated in a community panel discussion and Q&A featuring leading health experts including (Dolly Doctor) Dr Melissa Kang, senior lecturer at the School of Health and Social Development at Deakin University Maria Pallotta-Chiarolli and Alan McKee, who spoke on media and healthy sexual development.

North Coast Medicare Local

General Manager Chris Clark said the conference was well received by everyone who attended.

“We have received some great feedback from various sources all pointing us to the fact that we need to do more to strengthen youth sexual health issues and services on the North Coast”.

More info about the conference and to watch videos from the event visit www.healthynorthcoast.org.au/pash

On March 21, Closing the Gap Day was held at the Birpai Land Council site in Port Macquarie. The day coincided with the opening of the land coucil's brand new outdoor kitchen, vegie patch and chicken coop.

There are plans to hold cooking classes at the site using produce from the garden. NCML recently held its First Aid in Community training in this new outdoor space.

NCML in the community Larissa Graham preparing food in the new outdoor kitchen at Birpai Land Council. NCML recently held its First Aid in the Community training in this new outdoor space.

eHealth consumer registration member Aimee Doyle staffing the NCML stall at the Check Your Head youth music event in Coffs Harbour organised by headspace.

HealthSpeak A publication of North Coast Medicare Local

Students taking part in PASH 2014 - the North Coast Regional Sexual Health Conference held in Byron Bay.

winter 2014

NCML held a stall at the Tweed Heads Closing the Gap Day at the Civic Centre. Here children from the Kids Caring for Country group enjoy an activity with Lara Bennett from the Family Centre in Murwillumbah.

11

Help to prescribe a non-drug therapy The Handbook of NonDrug interventions (HANDI) is making effective non-drug treatments more visible and easier to use HANDI, which is auspiced by the Royal Australian College of General Practice, aims to make 'prescribing' a non-drug therapy almost as easy as writing a prescription. The information in HANDI has been submitted by the HANDI Project team and is supported by appropriate evidence.

Advances in non-drug treatments in the past few decades have been substantial and diverse: exercise for heart failure and COPD, the Epley manoeuvre for benign paroxysmal positional vertigo, knee taping for osteoarthritis, cognitive therapy for depression (and almost everything else), ‘bibliotherapy’ (specific guided self-help books for some conditions), to name just a few.

Nearly half the thousands of

clinical trials conducted each year are for non-drug treatments.

However, the effective non-drug methods are less well known, less well promoted, and less well used than their pharmaceutical cousins.

Until now, there has been no reference resource for non-drug treatments.

The HANDI project is a commitment by the RACGP’s National Standing Committed for Quality Care to promote effective non-drug treatments which have solid evidence of their effectiveness.

HANDI enables clinicians to offer a greater choice of interventions to a patient, who may wish to avoid pharmacotherapy and the risks and life style changes often associated with drug treatment regimes.

View HANDI at: www.racgp.org.au/ your-practice/guidelines/handi/about/ the-handi-project/

GPs FOR NEW PRACTICE TWEED COAST, NORTHERN NSW seeking VR and non-VR GPs flexible hours if required new purpose built modern medical centre fully computerised mixed billing nurse and administrative support access to onsite allied health excellent beach side location opportunity to become part owners must be willing to share roster including after hours and nursing home visits after-hours work available for International Medical Graduates Email tvoffice@westnet.com.au for an information package

12

Pearls of the Harbour a night of inspiration

Popular Coffs Harbour Mayor Denise Knight was the MC and also helped serve food.

An over 30 women’s health evening organised by North Coast Medicare Local and Coffs Harbour Women’s Health Centre (GenHealth) was sold out, with people being turned away at the door.

Fifty women came together in April at The Happy Frog vegetarian café to hear some hot tips on taking care of themselves and enjoy a threecourse meal.

Coffs Harbour Mayor Denise Knight MCed the event and inspired everyone with

her candid and often funny stories about her own cancer journey.

Speakers included GP Dr Jo Walker and Lisa Brown, who spoke on mindfulness and health. Berry Jones gave a presentation on care of breasts and Meagan Kelly demonstrated some physio, while Lily Isabella talked about secret women’s business.

The women attending rated the evening as informative, relevant and entertaining.

Multidisciplinary Event: ‘No Pain All Gain’ Late registrations are still open for North Coast Medicare Local’s multidisciplinary education event No Pain All Gain, to be held at Mantra on Salt Beach at Kingscliff on Saturday and Sunday June 14 and 15.

This two-day event is open to GPs, pharmacists, specialists, allied health professionals, nurses, practice managers and receptionists.

An exciting line up of speakers will deliver topics related to chronic pain and its management. There are three streams to ensure something of interest for everyone over the two days. To register, phone Anne Maclean on 6622 4453 or email amaclean@ncml.org.au HealthSpeak

No Pain All Gain A NCML Chronic Pain event for GPs, Specialists, Pharmacists, Allied Health Professionals, Nurses, Practice Managers and Receptionists Featuring: Agency for Clinical Innovation, and many other speakers.

Date: Saturday 14 and Sunday 15 June 2014 Venue: Mantra on Salt Beach, Kingscliff Dinner: Saturday 14 June 2014

A publication of North Coast Medicare Local

winter 2014

Understanding health professionals: Looking at podiatry Podiatrists are qualified health professionals specialising in the prevention, diagnosis, treatment and rehabilitation of disorders, medical and surgical conditions of the feet and lower limbs.

The podiatrist’s scope of practice includes paediatrics, diabetes, sports injuries, structural problems, treatment of the elderly as well as general foot care.

The complex mechanics of feet (52 bones, a network of muscles, joints and ligaments) and a wide range of foot problems (over 200 identified conditions) demand professional expertise.

Podiatrists must attend uni-

versity for three to four years studying treatment and physiology of the lower limbs and feet.

Specialities are chronic illness (diabetes, neuropathy, arthritis), paediatric, aged care, sports medicine, orthotics for foot correction and general foot care (corns, callouses, ingrown toenails etc) Australian Podiatry Association members practise under a strict code of ethics and adhere to compulsory guidelines on infection control of the NSW Department of Health.

Information from Australian Podiatry Association website: www. podiatry.asn.au

Profile Podiatrist David Shaw David is the Director of Rightfoot Podiatry with 10 clinics throughout the Northern Rivers. He came to podiatry through his interest in lower limb mechanics.

He initially studied Human Movement studies at the University of Queensland (UQ) and after finishing his degree, he worked as a conditioning coach for a number of rugby league and union teams as well as for track athletes training at UQ. “I then looked into doing a Masters of Biomechanics, which wasn’t very specific.

In training athletes at the UQ track, I came to work with a consulting podiatrist and became interested in the profession that way. So I started the Podiatry degree offered at the Queensland University of Technology the following year.”

David says his working days now are different to when he first started.

“I began work in 2002 as a locum throughout the UK, mostly within the public health system. This was a terrific way to see the country and earn money to jump over to Europe between jobs. “

He told HealthSpeak that working within the NHS he practiced in every facet of podiatry, from high risk wound care to biomechanics, paediatrics and general toenail and callus care. He also did some private work at the English Institute of Sport in Bath.

The cold climate saw David come back to Australia, and he worked as a locum around the Northern Rivers area for Leah Cook (Podiatric Surgeon) until the Aussie summer ended and he went back to the UK to do it all again.

At the end of 2004 he finally moved back to Australia and set up his own practice in Ballina.

“The days then mostly involved routine toenail cutting for the aged and high risk patients, sporting and paediatric foot and ankle problems, and minor surgeries for ingrown toenails and warts.

“These ratios are roughly the same in my practice today, although I spend around 20 per cent of my week managing and monitoring my business nowadays,” David said.

David loves his work, which he finds very satisfying. He says he’s employed more than

HealthSpeak A publication of North Coast Medicare Local

winter 2014

Every graduate who wants work gets it.

20 podiatrists over time and thinks most wonder if they’ve made the right career choice for the first few years.

“But, after you get over the ‘four years of practice hump’ it all becomes easier and more automatic. This means conversing with your patients extends beyond the clinical aspects of their care into more general topics.

“Provided you are careful

with what you talk about and you stay within each other’s comfort zones this is where consulting becomes fulfilling and engaging. I always say that working with the elderly is priceless, they’ve been there and done that. And if you can’t learn something from every patient that comes to see you then you aren’t listening. “ David says podiatry pays well and their professional training means podiatrists can do more than almost everyone expects of them.

“If you are science minded and can get over dealing with feet while you are at university then podiatry is a perfect profession to consider. It also provides pathways like research or specialisations in sports podiatry, podo-paediatrics or diabetic foot care.

“You can do a post-graduate Masters in Podiatric Surgery and if you succeed, after that you can become a Podiatric (Foot & Ankle) Surgeon. And if you decide it’s not for you after a few years it’s a great undergraduate degree to have prior to studying Medicine (General Practice or other).

“Furthermore, every graduate who wants work gets it.

You can’t say that for many professions these days,” he added.

13

More GP services for the Tweed Coast Community Local businessman Brian Eddy has a passion for providing accessible general practice health services to the Tweed Coast Community. A long term resident of the Tweed Coast, Brian has seen firsthand the need for more general practice services in the area. In particular the need for more primary health care services to the aged and homebound. “I am creating a medical service that has an emphasis on providing services to those members of our community that want to remain living independently in their own home” Brian said.

After two years of planning Brian will be establishing a new practice in Kingscliff that will focus on providing at home services, services to aged care facilities and after hours care. His future plans include establishing additional sites at Casuarina and Pottsville. “I plan to establish a network of services that are responsive to the needs of the community. If the patient’s needs are

The new practice will be located in Kingscliff’s Azura complex.

women’s health services, pain management clinics or visiting specialists, I will work hard to make these services available”.

Recently Brian had the opportunity to attend after hours home consultations with a local GP “I was moved by seeing how patients struggle to manage to stay in their homes, especially for the aged and those with a disability. One family with two disabled children had a very difficult time in trying to find health

Briefs

14

Nitrous oxide safe

Fingers and OA

A new study has declared laughing gas to be safe, after years of debate within the medical community.

Nitrous oxide, or laughing gas, was first used as an anaesthetic for surgery patients over 160 years ago. Now a study led by Professor Paul Myles from Melbourne's Alfred Hospital proves the drug is safe.

“We had been quite concerned about these potential, and they were potential, effects. But these results are completely conclusive,” he said.

The study documented the effects of nitrous oxide on 7,000 patients in 45 hospitals around Australia, Asia, North America and Europe.

Prof Myles says it will return a cheap and safe anaesthetic to patients and hospitals.

The length of a person’s finger could indicate their risk factor in developing osteoarthritis (OA) later in life, a study has found.

The study measured ratios of index–to–ring finger lengths (2D:4D) and correlated them with rates of knee and hip replacements.

In the 11 years following the initial finger measurements, a total of 580 knee replacements and 499 hip replacements were reported from the 14,000 middle aged and elderly people evaluated.

Dr Yuanyuan Wang from Monash University, who led the study, said the findings supported the belief that hormonal factors played a role in the origin, development and resultant effects of OA, and possibly account for gender differences in its prevalence.

services that could come to their home when needed. By listening to what the community needs I believe the Kingscliff practice will address some of these concerns”.

The practice at Kingscliff, is to be called Beachside Family Medical Centre. The Medical Centre’s vision is to provide

health care to all those who need assistance, not simply those who have the capacity to physically attend a practice. Whilst remaining financially viable, concentration will be on the provision of community service rather than the development of a commercial enterprise.

The Medical Centre will have as its Medical Director Dr Zool Hudda and will be recruiting at least four GPs. The Centre will also be recruiting a Practice Nurse, Practice Manager and Medical Receptionist. The centre will have onsite allied health (physiotherapy and exercise physiology) as well as onsite pathology.

For further information about this community focussed Medical Centre please email tvoffice@westnet.com.au

Nurses top the trusted professions (again) The Roy Morgan ‘Image of Professions’ survey of 2014 has found nurses are the most highly regarded, followed by doctors, pharmacists, dentists and High Court judges.

The telephone survey polled 644 Australian men and women aged 14 and over.

Ninety-one per cent (up one per cent on the highest rating since 2007) rated nurses as the most ethical and honest.

Other professions that also gained high ratings for ethics and honesty in 2014, included doctors (86%), pharmacists (86%), dentists (74%), High Court judges (74%), engineers (72%), school teachers (72%), police (71%) – the highest ever rating for police and state Supreme Court judges (70%, unchanged).

Amongst the biggest losers were Ministers of religion (37%, down 7%) recording their lowest ever rating for ethics and honesty since being included on the survey in 1996, business executives (18%, down 4%), union leaders (12%, down 3%) – their lowest rating since HealthSpeak

2002 and real estate agents (9%, down 3%).

Federal MPs (12%, down 2%) and State MPs (12%, down 1%) both lost ground since last year whilst the lowest ranked profession is once again car sales people (3%, down 1%) – a position they have held for over 30 years with the next lowest being advertising people (8%, down 1%).

A publication of North Coast Medicare Local

winter 2014

Aged care rights and advice TARS (The Aged Care Rights Service) is a community legal centre based in Sydney that provides advocacy for the residents of Commonwealth funded hostels and nursing homes and recipients of in-home aged care in NSW. It also offers legal advice and advocacy for residents of selfcare retirement villages and legal advice and information to older people in NSW – advice such as consumer rights, human rights and elder abuse, financial exploitation and planning for later life.

For residents of country NSW, TARS can be reached on 1800 424 079 and all calls to TARS are confidential.

TARS also produces a range of useful publications such as ‘Five Steps to Entry into Residential Aged Care’ and ‘At Home with Dementia’. These may be accessed at: http://www.tars.com. au/index.php/publications/otheruseful-publications Information on financial aspects of aged care The National Information Centre for Residential Aged

Consumers can speak directly to an information officer.

A snapshot of the easy to use TARS website

Care (NICRAC) operates an information line to help those needing guidance on financial matters when moving into a residential aged care facility.

Often a major health event triggers the need for placement into age care occurs suddenly, therefore making important financial decisions quickly is required. Without the relevant information that can be related to

the individual and their families, can often bring about negative consequences down the track.

Consumers can speak directly to an officer to discuss the many aspects requiring consideration around such a move. Information such as the costs involved with the various types of facilities, the assessment of Government income support eligibility, estate planning, the family home

and other financial assets as well as how the transition can impact on a partner if applicable.

NICRAC’s CEO Wendy Schilg said there’s been a steady increase in demand for aged care related information.

“At present there is plenty of information out there but our feedback suggests that consumers are finding it increasingly difficult to access financial information on aged care at short notice that is free, confidential and unbiased. On top of this consumers generally wish to speak directly with an information officer who can discuss it in relation to their personal situation.”

To speak to an officer about financial information on residential aged care, contact NICRAC on 02 6280 0234 Monday to Friday, 9am to 5pm EST.

Nightingale’s birthday and all that goes with it!

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

This edition of HealthSpeak coincides with two important international events with which the School of Health and Human Sciences will be involved.

International nurses Day with the theme this year being,’ Nurses: A force for change-a vital resource for health’; and International Day of the Midwife with the theme, ‘The world needs midwives now more than ever’.

The School offers both of these degrees; undergraduate programs which lead to registration as a nurse or a midwife within Australia. The

international events will be acknowledged in many ways by the school including the cohosting of a conference with the North Coast Local Health District, (NCNSW LHD), under the theme of, ‘Nursing impact on patient care’.

This partnership with the

HealthSpeak A publication of North Coast Medicare Local

winter 2014

NNSW LHD, is achieving much success in establishing new educational pathways, building research capability and clinical and academic role development. Students from both programs have clinical placements in a range of NNSW LHD facilities throughout the North Coast.

Judging by the letters I receive praising many of our students, it seems their impact is being noticed.

Florence Nightingale wrote extensively about both nursing and midwifery. She presented many revolutionary ideas, many of which have still to be implemented. The cornerstone of her philosophy, which drove her writing was focused upon placing the person in the best position in order to allow nature to act upon them. Her

work speaks about rest and activity, nutrition and hydration, of an environment equipped to facilitate ease and recovery, as well as ensuring intellectual and spiritual healing.

Nightingale is recognised first and foremost as a reformer, someone equipped to make informed change. A noted researcher and statistician she used evidence to drive reform. It is important for the School, here at SCU, to carry this on by the way we ‘school’ the students and allow them to experience healthcare in a fast changing world. So join us and many others across the globe in marking these two days by acknowledging what they stand for and the benefits they help bring about to all in terms of our health and wellbeing.

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Understanding health professionals: Looking at osteopathy Osteopathy is a form of manual health care which recognises the important link between the structure of the body and the way it functions.

Osteopaths focus on how the skeleton, joints, muscles, nerves, circulation, connective tissue and internal organs function as a holistic unit.

Using skilled evaluation, diagnosis and a wide range of hands-on techniques, osteopaths can identify important types of dysfunction in your body. Osteopathic treatment uses techniques such as stretching and massage for general treatment of the soft tissues (muscles, tendons and ligaments) along with mobilisation of specific joints and soft tissues.

Osteopathy is covered by most private health funds and the Chronic Disease Management (CDM) scheme. Osteopaths are registered providers

Osteopaths can identify important types of dysfunction in your body.

for workers’ compensation schemes, motor accident insurers and the Department of Veterans’ Affairs.

In Australia, all osteopaths complete a minimum of five years university training in anatomy, physiology, pathology,

general medical diagnosis and osteopathic techniques. They are also trained to perform standard medical examinations of the musculoskeletal, cardiovascular, respiratory and nervous systems. These university graduates hold either a double

Profile Osteopath Sharon Frazer Sharon’s interest in sports injuries came about growing up in Bega, a small town on the NSW South Coast where she spent a lot of time on a tennis court.

“I became interested in treating sports injuries and as there weren’t any osteopaths nearby, my initial interest was in physiotherapy and I observed several in my home town.

“Once I was introduced to the idea and scope of osteopathy at the end of school it then became my focus,” she said.

Her five-year study in osteopathy was completed in Melbourne, with the course involving a lot of hands on work, including working in a student clinic twice weekly for the final two years.

Sharon and her husband Dale own Life in Motion Osteopathy Clinic at Tweed Heads.

16

From left: Dale, Wil, Sharon, Jake and Abby Frazer.

“We have three osteopaths working in our clinic. Our work involves 40 minute hands-on manual therapy sessions that include soft tissue massage, muscle stretching and gentle joint articulation.

“I then use dietary and exercise advice to improve each person’s long-term outlook,

by empowering them to become responsible for their health at home. And we have an exercise room in our clinic where we demonstrate appropriate exercises to our clients.”

Sharon loves every aspect of osteopathy, particularly its wholistic approach. A consul-

HealthSpeak

Bachelors or Master qualification.

Osteopaths are required, by law, to maintain ongoing professional development and education to stay in practice.

In Australia, all osteopaths are required to be government registered practitioners. The register can be found at: http:// www.ahpra.gov.au/Registration/ Registers-of-Practitioners.aspx Information from the Australian Osteopathic Association website: http:// www.osteopathy.org.au

tation involves taking an in depth history and a clinical examination to assess the symptoms and which tissues are involved.

“The next question we need to answer is why the symptoms are there, as this improves the person’s long term prognosis by reducing reoccurrences of the same symptoms,” Sharon explained.

She also enjoys the hands on aspect, feeling the changes in tissues as things progress.

Client contact is rewarding, with Sharon often hearing wonderful stories from her clients.

Sharon said osteopathy’s strong, supportive practitioner network was another reason to consider osteopathy as a career. Osteopathy is available at three universities: Southern Cross University in Lismore; RMIT and Victoria University in Melbourne.

If anyone would like more information on osteopathy Sharon is happy to help. Call her on (07) 5524 6412.

A publication of North Coast Medicare Local

winter 2014

HealthSpeak has compiled a feature on the impressive work being done at the North Coast Cancer Institute that was showcased at the North Coast Cancer Conference earlier this year.

Here are a few snapshots to illustrate the nature of the multidisciplinary collaboration and leading edge technology used by the dedicated staff across the Northern NSW and Mid North Coast Health Districts.

NCCI Innovation

feature

Technology and innovation the key to improved results Sexual practices link to head and neck cancer Head and neck cancers are the sixth most common cancer worldwide with three times as many men as women developing one of these cancers.

In March, Dr Patrick Dwyer, a radiation oncologist with North Coast Cancer Institute (NCCI), gave a presentation at the North Coast Cancer Conference on the fact that the demographic of head and neck cancer patients has changed significantly over the past couple of decades.

Dr Dwyer spoke to HealthSpeak about this development and how NCCI is using technology and the skills of its staff to increase survival rates for head and neck cancers.

“In hospital and in the community, we are used to seeing head and neck cancer patients who are the typical heavy drinkers, heavy smokers - old men with lots of other medical problems who are very difficult to treat because of those medical problems and their outcomes are not so good.

Changing demographic “Now we’re seeing the emergence of viral-related cancers, specifically Human Papilloma Virus or HPV related head and neck cancer and it’s still rising in incidence,” said Dr Dwyer.

And along with the shift in what causes these oropharyngeal cancers, the demographic has changed.

NCCI, along with the rest of the world, is seeing more younger male patients with a higher socioeconomic status developing these cancers which are less associated with

smoking and drinking alcohol and more commonly associated with changing sexual practices over the past few decades.

“These cancers are associated with earlier sex, more sexual partners and more oral sex which increases the incidence of HPV,” Dr Dwyer explained.

He said the incidence of such cancers was expected to peak within the next 10 to 20 years, but on the upside, the outcomes for these patients is much improved compared to HPV unrelated head and neck cancer patients.

However, smokers with HPVrelated head and neck cancer have a less optimistic prognosis, and marijuana smokers an even lesser chance of a good outcome.

Survival rates Dr Dwyer said that the relative survival benefit for HPV-related head and neck cancer patients seems to be independent of therapy. And the absolute survival difference for HPV positive patients at five years was consistently greater than 30 per cent.

Treatment outcomes Radiation therapy is the backbone of any definitive head and neck protocols for organ preservation.

Over the past four years, NCCI has treated 48 head and neck cancer patients, mostly with chemotherapy and radiation combined, and some just with radiation alone.

“We’re showing pretty good results, about 93 per cent of patients have locoregional control, meaning they have no disease left behind in the head and neck, and 90 per cent of our patients are still alive. Our data is still very immature. These are stage 3 and

HealthSpeak A publication of North Coast Medicare Local

winter 2014

Patrick Dwyer

4 patients, so locally advanced cancers with historically only 50 to 60 per cent survivals. And so far we’re getting 90 per cent locoregional control, but we need longer term follow ups to firm up our data,” said Dr Dwyer.

Treatment advances NCCI is on the leading edge of treatment technologies and protocols due to its resources and the talents of its multidisciplinary staff.

“We’re using IMRT – intensity modulated radiation therapy. We have very good targeting of tumours because we have MRI and PET scanners available locally to be able to delineate the target in the normal tissues very well, and we’ve got modern treatment planning systems that can allow delivery of high doses to the targets and low doses to the normal tissues,” Dr Dwyer told HealthSpeak.

The benefits of IMRT include better sparing of normal tissue, more dose conformality to target and the possibility of dose escalation.

NCCI has developed in house head and neck cancer treatment protocols and staff are involved in writing EviQ protocols (NSW Cancer Institute online protocols that provide health professionals with current evidence based, peer reviewed, best practice cancer treatment protocols and information).

The use of IMRT and rigorous Quality Assurance means the treatment parameters can be delivered on the radiotherapy machine. And following treatment, NCCI has its allied health team to support patients through this stage.

“We have social work support, nursing support to support patients through treatment and long-term follow up as well the recipe you need to get good outcomes,” said Dr Dwyer.

Patients are usually ‘worked up’ by a multidisciplinary head and neck team, with most patients coming from either the Princess Alexandra Hospital in Brisbane or the Gold Coast University Hospital.

“I attend a couple of multidisciplinary meetings via tele-conference and discuss the patients and then if they are from this region they are referred back here for treatment. So there’s usually only one visit up the coast before the patient comes back here for treatment. We have all the tools and techniques and diagnostic treatment that they need.”

HPV and cancer Dr Dwyer said that while a lot was known about the link between HPV and cervical cancer (much more common than HPVrelated head and neck cancers), Continued next page 17

feature NCCI Innovation From previous page the link to head and neck cancers was not well known.

He is hopeful that this rise in HPV-related cancer will dip again eventually due to the HPV vaccination and screening.

“There are very promising results with cervical cancer reduction from Gardasil [HPV vaccine]. It’s reducing the incidence of warts and high risk HPV virus types, so let’s hope that will translate into reductions in cervical cancer and the incidence of head and neck cancer as well.”

Dr Dwyer said the fairly recent drive to vaccinate 12 and 13-year old boys in schools would also help stem the problem.

“And in addition, having the herd immunity of women being vaccinated reduces the general population incidence of HPV,” he added.

Patients in shock As mentioned, the link between HPV and head and neck cancers is not generally known in the community and Dr Dwyer said young men were shocked when the discussion came up in the clinic.

“They want to know, ‘How did I get it?’, ‘Can I give it on to anyone else?’ We’re learning to deal with these questions in the best way.

They are things you didn’t have to inquire about in a history when talking with a typical head and neck cancer patient.

“It can put some stress on relationships between patients and partners. But we know how important the partner is getting the patients through the treatment. But it’s all completely new and different.”

Support group The NCCI’s allied health team is involved in setting up a support group for patients in the lead up to treatment in the follow-up period afterwards.

Dr Dwyer explained that HPV-related cancer patients have a bigger drop in their quality of life during treatment than HPVunrelated cancers.

“You wonder if it’s because they haven’t abused themselves

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so much [with smoking and alcohol] and we go and give them a pretty intense treatment that really tests them. So they have a bigger reduction in quality of life that can take up to two years to recover from,” Dr Dwyer said.

The most frequent complaints from this cohort of younger men

are about changes in taste and a reduction in saliva (dry mouth).

These patients are less affected now by swallowing issues and by pain, which were the common complaints with old-style treatment techniques.

And given the larger number of long-term survivors - younger

patients who are big contributors to society, and the impact on quality of life after treatment - there is a lot more emphasis going on survivorship issues and lifestyle medicine and the importance of having a good relationship with your GP and access to allied health practitioners.

Grafton Telelink a success A change in care boundaries in 2012 meant that patients in Grafton who had been cared for by haematologists from Coffs Harbour became the responsibility of Lismore North Coast Cancer Institute clinicians.

For NCCI consultant haematologist Associated Professor Ram Seshadri this meant he became responsible for a large number of patients from the Clarence Valley District. There were also the difficulties faced by patients in travelling over 1.5 hours each way for an appointment.

Fortunately, last year, the Federal Government provided funding for a Telelink system which has proved successful across the world.

NCCI uses Microsoft Lync which is similar to Skype. Patients are booked for a Telelink consultation, currently held on Monday afternoons. Ram’s practice was an obvious choice to take up Telelink as he explained to HealthSpeak.

“Specialties such as haematology and oncology are well suited to Telelink because with these patients you don’t need to perform physical examinations all the time.

“The Telelink system has been running successfully now for over a year. When the system was first set up there were some initial problems with the audio, which has now been rectified.

“The patients have their blood tests and investigations completed beforehand and by the time they come to their consultation with me I have

reviewed their results which enables me to discuss their issues and talk about their problems. Sharyn Hurford, our Clinical Nurse Consultant in the Grafton Oncology Unit can perform a brief examination, if it’s a serious issue.

Often I ask the patient to go to their GP on that day or come to Lismore Haematology Clinic if it’s really needed,” Ram said.

“On the completion of the Telelink consult, I dictate a letter to the referring GP recommending management. Follow up management is conducted in close collaboration with the GP. Copies of correspondence and reports are kept with both the Grafton and Lismore patient files for continuity of service. In the future, with the help of electronic medical records, we hope to improve the continuity of care.

“If the patients need paperwork for prescription, investigations etc. these are written up and faxed to Sharyn who passes them on to the patients with instructions.

If treatment is required, we have a computerised treatment ordering protocol which is faxed through and Sharyn is also able to view the orders online” said Ram. Ram may also consult with new patients via Telelink providing their case is not complicated.

“If the case is complicated such as leukemia,

HealthSpeak

the patient will be requested to come to the Haematology Clinic in Lismore to have their diagnosis and a treatment plan explained to them. They will be able to ask questions and discuss further management and prognosis. The treatment plan will be performed at Grafton Base Hospital and supported by physicians who are also available.”

Ram said that although patients were initially apprehensive about using the remote system, a recent Satisfaction Survey showed a high satisfactory level and excellent service approval.

“They like the service as it saves them travelling to Lismore for consultations. This choice is especially welcomed by the elderly including a 90 year old. The service also saves on petrol and, tongue in cheek, I say it is saving the environment too.”

Ram would like to see Telelink extended to GPs and home situations for patients with the help of the National Broadband Network.

A publication of North Coast Medicare Local

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NCCI Innovation

feature

Making a difference for lung cancer patients At Port Macquarie, members of the North Coast Cancer Institute (NCCI) health team are working on new approaches to more effectively treat lung cancer, the leading cause of cancer related death within Australia.

Some of these approaches include techniques rarely employed in Australian centres, some of it leading edge work for the nation and particularly impressive in a regional cancer Institute.

It’s hoped papers will be published before long on the institute’s experience with these new lung radiation therapy techniques and patient outcomes.

The knowledge gained on the North Coast is also regularly shared at scientific conferences.

HealthSpeak spoke to Gareth Livingston, a Clinical Thoracic Specialist (Radiation Therapist), whose role since October 2012 has been to investigate and lead implementation of recent radiation therapy advances.

Gareth said there was something of a shift going on right now in regards to the treatment of lung cancer.

“Advances in our understanding of the molecular pathogenesis has led to drug therapies designed to target specific ‘driver’ mutations for certain diseases, whilst improved technological capabilities has also allowed disciplines such as Radiation Therapy to make significant advances in its approach to lung cancer treatment,” he said.

Gareth’s role within NCCI is to help provide a pathway to improve the quality of treatments for patients suffering lung cancer with the Northern NSWand Mid North Coast Local Health Districts, in line with world’s best practice.

Some of the improvements clinicians at NCCI have seen over the past 18 months include: 4D imaging This allows clinicians to visualise the patient specific movement of a lung tumour at both

Gareth Livingston

the planning stage and treatment stage of radiotherapy. It provides more accurate information regarding the true location and shape of a tumour than conventional CT scans.

This has the dual purpose of both ensuring target coverage and minimisation of dose to surrounding tissues and organs (including lungs, heart, oesophagus, airways etc.)

SABR treatment Early stage disease treated with SABR doses (large doses of radiation delivered in 3 to 5 treatment sessions) has been shown to have excellent outcomes for patients with inoperable disease.

Sadly this is a significant proportion of early stage lung cancer patients given smoking related co-morbidities.

Implementation of SABR relies heavily on both the 4D capabilities discussed above and a high level of understanding of the issues surrounding dosimetry and target motion by the Radiation Oncology team.

“SABR treatments for lung patients are a huge step forward for NCCI with our first case being treated in Lismore in late 2012. SABR is now commonly used within NCCI to treat certain stage I disease,” Gareth told HealthSpeak.

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Success is the result of of the wider team’s work as opposed to any individuals.

Later stage treatment Patients requiring 20 to 30 treatment sessions have also had a change in technique, moving towards IMRT (Intensity Modulated Radiotherapy) as the standard of care.

IMRT has had reported benefits from renowned international centres. This technique has improved the dose received by critical organs such as the lungs and oesophagus. Issues surrounding IMRT delivery to moving targets (tumours in the lung are always moving as the patient breathes) have been overcome within the NCCI and IMRT has been implemented since late last year.

While data collection on these patients continues, decreases in high and low doses received by the lungs as well as a decrease in dose to the oesophagus have been realised at the NCCI. “This can help reduce the risk

of radiotherapy side effects such as pneumonitis and oesophagitis and the NCCI will aim to publish and present this data and findings by the end of 2014,” Gareth said.

The way ahead Other work has been done collecting data relating to the stabilisation of lung patients (how still they are during the delivery of radiotherapy).

“This work is being submitted for publication, however understanding this in combination with our 4D imaging capabilities can open the door for further advances in radiotherapy for lung cancer. This will be the scope for short to medium term,” Gareth said.

Gareth was at pains to point out the contributions made to this work by the entire NCCI team. He said his role was to lead clinicians and therapists where necessary but also to coordinate the high level of work done by others to drive quality improvement.

“NCCI is tremendously lucky to have the highly skilled workforce it does with huge emphasis on team work, a staff committed to positive evidencebased change and management committed to research. This integrated approach is the key, and any success we see at NCCI is the result of the wider team’s work as opposed to any individuals.”

NCCI feature continued on page 29 19

The Koori Grapevine How physios can help close the gap

By Ray Gates Last year I had the pleasure of attending the launch dinner of the Australian Physiotherapy Association’s Reconciliation Action Plan.

A fairly momentous occasion, not the least of reasons being that this is something that a number of Aboriginal physiotherapists including myself have campaigned for over the last four to five years.

But, as much as I was pleased to see Australia’s peak body for mainstream physiotherapy finally stand up and formally commit to contributing to closing the gap in Aboriginal and Torres Strait Islander health, what I found even more inspirational was the number of physios – Indigenous and non-Indigenous – who joined the celebration and appeared genuinely committed to the APA’s vision of achieving equitable access to physiotherapy for Aboriginal and Torres Strait Islander peoples.

For me, this went a long way towards validating a belief that I’ve held since becoming a physio 11 years ago: that physiotherapists and the physiotherapy profession can make a significant difference in improving the health status of Aboriginal and Torres Strait islander peoples.

Physios have the knowledge and skill set to address a number of conditions including those considered to be the big issues within Aboriginal health – cardiovascular disease, diabetes, and acute and chronic injuries.

We can be found in almost all health settings, from hospitals, medical centres, and private practice clinics, to aged care facilities and community-based services. Some work directly with Aboriginal communities, either through Aboriginal health Services or mainstream clinics.

Many physios are primary health care practitioners, and for many patients can represent the entry point into the health system.

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Physiotherapist Ray Gates

As such, physios are both wellpositioned and well-equipped to provide a high level of care to Aboriginal and Torres Strait islander peoples, either through direct intervention or broader care management. For example, referring to appropriate and relevant care providers, and in doing so, making a significant and meaningful contribution to closing the gap in health status.

In establishing its Reconciliation Action Plan, the Australian Physiotherapy Association, and more specifically its members, can and should play a significant role in improving health. More than that, it recognises that improving the health of Aboriginal and Torres Strait Islander peoples is not just about getting patients through the back door, but about changing the attitude and approach the profession and professionals have towards this critical issue.

It acknowledges that improving health is not just about diagnosing, treating and managing symptoms; it is about addressing all the issues that contribute to a significantly lower health status, such as cultural and social justice issues. And the commitment to developing a profession and a workforce that holds those values in high esteem can hopefully only result in positive outcomes for Aboriginal and Torres Strait islander health.

The onus is now on physiotherapists to drive the profession

Koori Grapevine

towards the goals set out in the Reconciliation Action Plan. It’s u to practitioners to look at the disparities in health status and say ‘this is not good enough, and we will do something about it’. After all, in becoming healthcare providers, we have made a commitment to care for those who could benefit from our services.

Surely then, we have a moral and ethical obligation to close the gap in health status between Indigenous and non-Indigenous peoples. If we truly believe that all people should be able to enjoy optimal health, then it stands to reason that we must first ensure that we’re all starting to move towards optimal health from the

same level.

This is what physios can contribute to closing the gap, and in dong so, I believe they can lead the way for other allied health professionals to take up the challenge and do the same. And when that happens, we can look forward to the day when there will be no more gap.

To view the APA’s Reconciliation Action Plan, go to: http:// www.physiotherapy.asn.au/ DocumentsFolder/Advocacy/ APA_RAP.pdf Ray Gates is an Aboriginal physiotherapist based on the Gold Coast.

Read his blogazine Indigihealth International at indighealth.com

NCML hosts Aboriginal Services Forum

NCML’s Helen Lambert opening the Forum at Coffs Harbour.

On Wednesday April 9, North Coast Medicare Local hosted the second annual Aboriginal Services Forum with 53 people attending from a wide range of community services.

NCML’s Mid North Coast Closing the Gap team organised the popular event at the Cex Coffs Club.

A total of 21 speakers took the opportunity to address the gathering and explain

what their service offered the Aboriginal and Torres Strait Islander community and how people could be referred to it.

The Forum aims to provide a space for information, collaboration and improved service delivery through networking and presentations.

Participants say they value the opportunity to get together and meet other service providers in a relaxed environment.

A publication of North Coast Medicare Local

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The uncommon art of the common man

By Janis Balodis The Gods of Wheat STREET is a television drama series about three generations of the Freeburns. It is about trying to make ends meet, about love and loss, jealousy and football – common everyday family issues.

“So what?” you may think.

What makes it uncommon is that it is set in Casino in the Northern Rivers, right now in the present, yet the characters have names of gods, heroes and heroines from Celtic, Norse and Greek myths. One character is a ghost, a spirit with a touch of magic. It is both moving and funny, often at the same time. And oh, the cast referred to themselves as “Black to the Rafters”, because the Freeburns are a common Aboriginal family.

The writer and co-producer Jon Bell grew up in Casino and currently lives there. It is clear he knows the Freeburns in heart and soul, for better and worse and it is all up there on the screen for us to see. He is a “big believer in being who you are, in coming where you come from and in sharing blessings in the community.”

Jon had a common writer’s journey. His family split up when he was four years old and his mother raised him. He trained in

Actor David Field (Harry Hamilton) on set in Casino with writer/ producer Jon Bell.

dance in the early 90s at Northern Rivers Conservatorium, tried a year of Indigenous Studies at Southern Cross University in Lismore, went to NAISDA Dance College in Sydney for a year, tried law for a year, and studied music and acting at Eora College for a year.

The time to knuckle down arrived with a new-born daughter.

Coming from such a strong performance background Jon needed a creative outlet. In 2001 he picked up a big, clunky camera and started making films, back in Casino. Editing happened in camera, press pause, set up the next shot and go on. “These days, technology has advanced so much that if you can find ten grand you can buy a camera, a couple of

lenses, some editing software and make a movie.”

The demands of single parenting and holding down a job led to creating on the page, writing.

Although Jon has watched so many films that he has absorbed how their stories are structured, he feels that his writing is more influenced by music and how songs work with melody and harmony. This is evident in how he shapes scenes and there is also a lot of music in The Gods of Wheat Street.

The last pillar that underpins this uncommonly captivating series is Narrative Therapy, which Jon encountered when working for DOCS. Narrative Therapy attempts to separate the person from the problem whilst holding

to the notion that a person is formed by their life’s experiences and stories. This allows for a story to be told and re-told from a different point of view, not as a victim but as a survivor, or as a hero or heroine. Or even a god.

The result is a series filled with such heart and infectious humour that you cannot help but like and cheer on the Freeburns. Finding the humour in any situation is a way of getting people to care, but Jon Bell’s bigger intention was to change the way in which mass media portrays Indigenous people.

Some of the local Aboriginal people got to play extras. They and their families watch the show completely engrossed until they see themselves or someone they know. “Hey, there’s Trevor.” They get a kick out of seeing their own stories and their own people there on screen, and they see them differently. Television makes a person and situation appear larger than life. Shifting perspectives shifts expectations.

Jon Bell’s uncommon achievement is that he has not only changed how the local Indigenous community see themselves, he has changed how the wider Australian community see a loving Indigenous family. And that can only be for our long-term uncommon good.

Everyone wins at Elders Olympics

By Russell Cavanagh, Aboriginal Outreach Worker, Port Macquarie On May 1, the Elders Olympics was this year held in Kempsey for the first time since the inaugural Olympics in 2001.

There were competing teams from out as far as Moree, down to the Central Coast and up to Bundjalung/Gumbanggir in the North. The day was very successful and the Elders said they thought it was good for the communities to see them out competing in a friendly yet competitive manner.

This gave community Elders the opportunity to meet up with old friends from their younger days and a chance for families to catch up in a festival environment.

North Coast Medicare Local emblems could be seen on various teams throughout the regions and the communities and

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Elders were very appreciative that NCML played a major role by enabling them to design their nations’ colours and emblems on some amazing Aboriginal art screen printed shirts.

The Elders who took part ranged from 50 to 80 plus years of age and everybody who was in a team took turns in their respective activity to put points on the score board for their mob.

The day was a spectacle of activities and colour with a lot of laughing, smiles, music and Elders dancing to music with a lift in their step.

Taree was the overall winner of the Elders Olympics, so next time this event will be held is in Biripi country. After the event concluded, the Elders commented that they were all winners. The closing ceremony included a march past with team banners.

A publication of North Coast Medicare Local

NCML staff at the Elders Olympics. Back, from left: Rhiannon Mitchell, Tara-Lee Morgan, Terry Donovan, Deb Cushing, Bronwyn Gainge, Front: Annie Orenshaw, Helen Lambert

A celebration dinner and Karaoke contest was organised for later in the evening for a final get together.

Koori Grapevine

21

Arts Health and Wellbeing Making sense of the world

By Janet Grist When I meet Joanna Kambourian at her art studio in the Lismore Art Space, she is upbeat and bubbly. Her words tumble out and she answers my questions with energy and passion.

Joanna is a contemporary artist, printmaker and graphic designer. A resident of Coraki, where she lives with partner Darren, Joanna has set up a studio called Ms Brown’s Lounge. The imagery she uses often features wallpaper patterns and domestic decoration to refer to markers of memory, narratives of cultural identity and belonging.

From an early age, growing up on Sydney’s northern beaches, Joanna demonstrated an enjoyment of creative work, and now she describes it as ‘central to her wellbeing’.

“It’s the enjoyment of doing, which is actually understanding. So, if I’m not doing, creating and making, I’m not making sense of the world I’m in. As a child you do that, but as an adult you’re often encouraged to stop and place your values elsewhere. I’ve tried very hard not to do that.”

Fresh out of school, Joanna wanted to be an artist but peer pressure meant her thinking was that ‘you don’t make any money doing that’. So she studied graphic design at Enmore Design College for a couple of years which she enjoyed as it was analogue, not computerised art. She then got a 9 to 5 job as a designer for a correspondence course company but quickly realised the workaday grind was not for her.

Joanna’s father Ron was a strong influence on her in many ways, and as an advertising art director for the big agencies, Joanna remembers him always in his study making something.

Father and daughter shared a love of handmade objects

Artist Joanna Kambourian in her studio in the Lismore Art Space.

and the wonder of making them.

At 21 Joanna’s world turned upside down when she was diagnosed with Graves’ disease, an auto immune disease affecting the thyroid.

“At that point, I thought work, career, I don’t care about that, it’s all about my health.

And for me the most important thing was my happiness quotient – managing the anxiety and the other stuff that goes along with Graves’ disease,” says Joanna.

She ended up moving to Port Macquarie and going to TAFE at Kempsey, and later to Southern Cross University in her mid-20s where she attained an Honours Bachelor of Arts degree.

“The whole thread of my life has been finding a way to have my creativity in the world and deal with survival and health and all the other things thrown at us. It’s always a challenge to keep that the main focus,” Joanna says.

“However, it’s been the right path.

Ten years ago I would never have dreamed I’d have a studio in the Lismore Art Space and be doing these things with people like (photographer) Ted Harvey and others. I get up every morning and feel so grateful to be doing what I am,” she adds.

Ms Brown’s 22

At 21 Joanna’s world turned upside down when she was diagnosed with Graves’ disease Lounge came out of her being in the United States and visiting a DIY community – people making wallpaper, fabric, handmade stuff, which she found really exciting.

“Printmaking was my chosen medium but when I saw this DIY, people making paper that hadn’t been done for years because the computer superseded everything, I wanted to set up a studio to experiment with all those things, primary the wallpaper and the printing.“ Joanna’s conceptual ideas are very much about identity – driven by her American Armenian/Dutch heritage. Her background means that she’s always felt she didn’t ‘fit in’ and has been a loner.

Going overseas and making family connections enabled her to find her confidence in the world and create Ms Brown’s Lounge.

Her wide ranging work has included playing with collages and making mandalas in Continued page 39 HealthSpeak

winter 2014

The art of shedding life’s burdens Monday mo rning tea

By Janis Balodis With apologies to Groucho Marx, there are men who don’t want to belong to any shed that would accept them as a member, and men who refuse to join any shed that accepts women as members. The first group probably has no idea what goes on and thinks the worst; the latter group thinks the worst and doesn’t want to know.

Men’s Sheds originated in Australia as a response to issues raised about men’s health, to encourage men of all ages to socialise and to take an interest in their own health and wellbeing.

Men’s Sheds offer men the opportunity to become part of a community, to connect to friends, and to keep an active mind and body by being productive. The Shed is also just a place where men can drop in to have a yarn and a cuppa if that is all they want.

Dean Box, the current President of Casino Men’s Shed puts it this way: “Men’s health is the important thing. If they make something on the side, well and good.”

There are over 1000 Men’s Sheds in Australia and each one is different, a reflection of its membership, their needs and available resources. There are five main areas of focus.

Workshops for those who wish to remain active, clinical and communal focus on promoting men’s health and wellbeing, recreational to foster social activities, and educational courses and training in skills such as cooking or using computers. Most Sheds would touch on all bases while focusing their activities on one or two. Most important is that a Shed should be a happy, relaxing, welcoming and safe environment.

Casino Community Men’s Shed accepts women as members. In fact, a woman, Merrilyn Cottee started the shed and got it running after several failed attempts by groups of men. For the first 18 months there was no money and no shed but the members held a meeting every Monday regardless. They now

a shed! now that’s

have very fine facilities indeed at the Casino Show Pavilion in a mutually beneficial arrangement with the Richmond Valley Council. An underused Council building is occupied three days a week in exchange for upkeep of grounds and buildings. The one proviso is that the Shed moves out for the one week of the year that the local show is in town.

Casino Men’s Shed has about 80 members, around 15 women, and it meets Monday, Tuesday and Wednesday from 8am till 2pm. Mondays begin with a catered morning-tea meeting where any business is transacted and people can just sit around and chat. Women carers bring some of the men along.

It costs $5 and there is usually enough left for lunch as well.

The workshop is busy all three days and there are art classes on Wednesdays led by Kyogle artist Ruth Reardon. More than one man said, “We like women here.

Keep us in line.”

The Shed is crammed with

HealthSpeak A publication of North Coast Medicare Local

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Merrilyn Cottee started the shed after several failed attempts by groups of men men & wom en at wor k

every conceivable woodworking and metalworking machine a man-boy could dream of. Bench saws, scroll saws, planes and thicknessers, sanders, wood and metal lathes, a welding corner, stacks of wood, recycled materials, leatherwork, art, sculpture, every way known to keep idle hands busy. Just want to sit and play cards or dominos – easy.

Yet Dean explains, “New members often wander round overwhelmed, mope about and do little. Then we give them a fluoro shirt with their name

[embroidered] on it and they are transformed. They’re into it.”

Members come from all walks of life. The Casino Men’s Shed does community work and projects, making toys, building nesting boxes for squirrel gliders, catering for the local drag races and BBQ fund raising at Bunnings and Woolies. They sell things they make at the Eltham Village Gallery.

The place is a hive. Get along on a Monday and catch the buzz. It’s good for your health.

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feature Terry Donovan

Belonging brings healing One man’s journey The Three Biripi Brothers Mountains are an important spiritual place for the local Aboriginal people of the NSW mid-north coast. It is a place where local Aboriginal people feel a connection to their country and their ancestors.

L

ast year, Terry Donovan, who works as an Outreach Worker for North Coast Medicare Local’s Closing the Gap program, was recognised for his exceptional service to the community of Coffs Harbour. He was awarded the prestigious Grace Roberts Award for Community Aboriginal Worker of the Year.

An unassuming man, Terry’s life has had its fair share of ups and downs and his experiences have shaped him into someone with a deep commitment to helping others and making a difference. He’s an ambassador, a role model and a mentor for his people and the white community as well.

Terry Donovan embodies reconciliation.

Janet Grist sat down with Terry to hear his story.

Terry was born in Taree in Biripai country in 1948. His father was a Gumbayngirr man and his mother a Biripai woman.

“I grew up on Purfleet mission, near Taree with my Nan, Adelaide Mitchell. She was a great woman, very quiet but when she spoke you listened. Growing up on a mission as a child was great. You didn’t see the anguish that the adults went through on a daily basis until you got older.”

This anguish included lining up every second Thursday to get rations and being under the thumb of the mission manager. In general Aboriginal Mission residents didn’t have freedom of movement but were required to get permission to leave and return. House inspections – where the manager or manager’s wife 24

HealthSpeak

went through the house to check for dust, cleanliness and tidiness - were held regularly.

Attitudes changed As he got older Terry saw the mission through different eyes and he began to wonder if mission life was normal. Was this the way people were looked after in Australia?

Going to the white school in Taree after the mission school closed was also a good experience initially for young Terry, with the kids getting on and enjoying each other’s company.

“But as we got into sixth class, the attitudes of the other kids changed and I couldn’t understand that, I was really confused. And on the street people would give you looks.

When he went to town with Nan on a Saturday she wouldn’t walk on the footpath, but on the side of the gutter. When Terry asked her ‘why?’ she said: ‘That’s simply the

A publication of North Coast Medicare Local

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Terry Donovan

I was never one to raise my fists or shout or hold the banner high, that wasn’t me.

But I wanted to make a difference for my family and my community

way it is’.

Terry says he’s grateful for these early experiences because he can now pass on this history in his Cultural Awareness classes.

Life after school Nan died when Terry was 13 and he left school and started hitchhiking all over the place looking for work. He worked on a banana plantation for some time and then at 16 he jumped on a train to Newcastle and got a job on the railways where he worked for five years until he was conscripted to National Service in the army.

He wasn’t sent to Vietnam which he now realises was a godsend, but at the time Terry, like most young men, wanted nothing more than to travel overseas and be on the front line.

In his mid 20s Terry got a lucky break and joined the National Parks and Wildlife Service in a newly created role. He was one of the first Aboriginal people employed as an Aboriginal Sites Officer.

A sense of belonging He travelled all around NSW gathering information about Aboriginal culture and history – documenting occupational sites and sacred sites and said he found a sense of contentment and a feeling of belonging.

“It was the very beginnings of finding out abut Aboriginal culture and after that here was a resurgence of interest all over Australia about Aboriginal identity. All of a sudden this pride came back into our people.

“I was 25 and naïve in a lot of ways but just listening to Elders talk about their people, they never sp oke about themselves, always about ‘the people’ and the stories they told were fascinating.”

The Elders would sit down and talk about culture and in between they’d weave stories about dance and song and their history.

“It’s all intermingled with our songlines and our ceremonies. One old fella out at Broken Hill said ‘Son, this is who we are, this is how we keep our history alive, through our dance and our storytelling and our art and that’s always stuck in my mind.”

These experiences changed Terry irrevocably, particularly a visit to Balranald, the site of a bloody massacre.

The Balranald massacre “Mrs Alice Kelly wanted to show us a site and she took us down to a bend on the Murray River. She wouldn’t go down herself, she asked us to go down and have a look and we found 49 skeletons w with the skulls bashed in. Females lying there with babies in their arms and kids wound around their legs.

“The hair on the back of my neck stood up and Mrs Kelly told us the story about how

feature

Terry’s career Artillery Man with the Australian Defence Force (1969-1972) Aboriginal Sites Officer for National Parks and Wildlife Service (19741977) Team Leader with Nambucca Shire Council (1978-1996) Supervisor with Ngarrala Aboriginal Corporation (1997-2003) Mentor, Youth Support and Case Worker with Wundarra Support Services (2003-2010) Aboriginal Outreach Worker with North Coast Medicare Local Coffs Harbour (2010-Present) Cultural Awareness Teacher with Coffs Harbour TAFE (2010-Present)

that unfolded.”

This barbaric mass slaughter was the result of this family clan killing a sheep for food.

When the owner of the property found the carcass he rounded up his men and some troopers and chased this clan from Menindi Lakes all the way down to the Murray where they were killed. The family members were either shot or bashed to death.

Terry still looks bewildered when he talks about this event.

“It just doesn’t wash, the English at that time were civilised enough to know the difference between right and wrong, so why perpetrate such a crime? From that time on I was a different person.”

Terry was now fuelled with a desire to help his own people. From 1975 onwards he wanted to make a difference.

“I was never one to raise my fists or shout or hold the banner high, that wasn’t me. But

HealthSpeak A publication of North Coast Medicare Local

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I wanted to make a difference for my family and my community and the best way I thought was to tell the truth, people have got to know the truth of our history. There are not to histories, a white and a black history, it’s all one history and it should be taught that way.”

Terry explains that Australia was not taken freely, but in a very volatile way.

“And those events of that time are still impacting on Aboriginal people today through the introduced foods for one. Once the sugars and all the other stuff started to come in it impacted on us in a way that we’re still suffering from today. Like type 2 diabetes, cardiovascular problems and that’s the reason for the Closing the Gap program, to turn this around.”

Resolving conflict Family responsibilities meant that Terry had to give up his Aboriginal Sites work and he got a job as a labourer with Nambucca Council, which he described as a red neck organisation at the time.

“That first day, walking in through those gates and having all these white people look at you, yea, it was hard, but once they got to know me things changed.”

Terry’s experiences in his previous role, coupled with his natural good humour, allowed him to keep relations harmonious at work. He went from a labourer to a team leader, supervising nine men and stayed with the council for 18 years. He was forced to retire due to a back injury which left him laid up at home for six months and feeling very low.

Retraining Wanting to support his family and get back into the workforce, Terry approached Ngarrala Aboriginal Corporation where he was retrained in bush regeneration and completed his Cert III in Environmental Studies.

Terry ended up leading a Green Team, mentoring young people, building their self Continued next page 25

feature Terry Donovan

The hair on the back of my neck stood up as Mrs Kelly told us the story about how that unfolded.

From previous page esteem and helping them get work experience which led onto real jobs for many.

From there, Terry got a job with Wundarra Support Services looking after troubled children who’d been taken away from their parents, a position anyone would find challenging.

“But no matter how challenging it was I felt good about doing it. I was there for seven years and thoroughly enjoyed it. I learnt a lot about communication with problem children and these experiences helped me on my way as well.”

After Wundarra, Terry got a job with the Mid North Coast Division of General practice (now North Coast Medicare Local) which is where he is today.

While he’d not worked in health before, Terry was surprised what a good fit he was in the organisation.

“All the skills I’d learned through the years I brought with me, especially communication skills which you really need when working with Aboriginal communities.”

Working in health Terry said Aboriginal Outreach workers also required patience as nothing happened straight away in communities. He is thankful for the introduction of the Closing the Gap program with the nation recognising that there are unacceptable differences in health outcomes between Aboriginal and non-Aboriginal Australians, which must be bridged.

“It’s only in its infancy, but it’s a great program. This program funding can’t afford to be cut off. The government always take money out of such programs too e arly, but it takes time for change to take place,” he said.

In his own community, Terry says he’s seeing change with Aboriginal people asking questions of him about health matters and Elders now going to a doctor for check ups.

He said a lot of health staff wonder why Aboriginal people don’t always keep their appointments.

Terry explained that the Aboriginal kinship system with its cultural differences, especially for Aboriginal women Elders, means that they will put their community responsibilities such as looking after children, ahead of a medical appointment.

“To make a difference we need to take the time to go into communities, sit down, have a coffee and a yarn and get around to topics like looking after yourself. We’re asking them to make a change in their lives and it will take time, but as Aboriginal Outreach workers we’ve got to take the time to get out there and say Hello. You have to build the relationships and I hope our program here continues to provide the flexibility for us to do just that.”

26

Terry with colleagues at Yarrawarra Clinic.

Terry and his wife Leanne at the awards ceremony in Coffs Harbour.

Shocking revelation Three or four times a year Terry teaches Cultural Awareness at TAFE with students of all ages and backgrounds.

One incident dramatically illustrates the oppression that Terry says Aboriginal people live with all the time, whether covertly or overtly expressed.

In one of his TAFE classes, there was a Sudanese girl and a Ugandan boy who sat up the back of the class and didn’t engage with Terry, not making eye contact or contributing.

When Terry asked the Ugandan boy to tell his story, he did so and afterwards asked if he could speak to Terry.

“He told me that when his family migrated, the Immigration officials told him to stay away from Aboriginal people because they were angry and volatile. The Sudanese girl said she was told the same thing and I’ve heard the same story from a Yugoslav man who migrated here 25 years ago. So the government is still oppressing Aboriginal people even today. This is what we have to put up with.

HealthSpeak

Countering racism “Forget about racism, that’s a fact of life. It’s all these other policies that the government is putting in place that impact on us. With racism, if it’s there you can fight that in some ways, but these other things….”

Sadly, Terry still experiences racism in Coffs Harbour. No long ago he and his wife Leanne were in the local mall food court looking at what they might order. Terry went to secure a table and Leanne was left waiting to be served for 20 minutes – everyone else around her was served but not her.

“I knew the girl serving had seen we were a couple and I went up to speak to her and finally asked to see her manager. When he came out he was 15 or 16 so I just said ‘Everything’s fine’ and sat down again.”

Leanne and Terry have nine children between them. All have done well with successful careers and one daughter raising a child with a disability in a way which makes Terry proud - although he’s clearly proud of every one of the nine children. Several are in the Defence Force and three of Terry’s sons have played in the NRL. Reconciliation While Terry can’t see reconciliation happening in his lifetime, he remains optimistic because he’s seen programs like Closing the Gap making a difference.

“But unless the rest of Australia embraces us as a people and a culture from which they can learn, reconciliation will never happen.

It’s not up to the Aboriginal people to make change, it’s up to all of us.”

Terry has some simple advice he knows can help.

“Walk down the street and instead of looking the other way when you see an Aboriginal person, nod and smile and say ‘Hello’.

It makes a difference. For an Aboriginal person, and I’ve experienced this, to walk down the street and see a white person coming towards you and looking at you and nodding, it makes you feel good because there’s a person who’s decent,” Terry said.

“All we want in life is to be on an equal footing to the rest of Australia. That’s all we ask.”

A publication of North Coast Medicare Local

winter 2014

Anaesthesia 2014: a specialty conference

By Amanda Shoebridge NCGPT Anaesthesia 2014, a conference designed especially for GP Anaesthetists and run by North Coast GP Training (NCGPT), is being held at the Opal Cove Resort in Coffs Harbour from 18th - 19th October 2014.

The final touches are being made to the program which includes a mix of plenary sessions, problem based learning discussions and a series of full day workshops to be held at the new Interprofessional Simulation Centre (iSimCentre) at Coffs Harbour Hospital. Organisers are pleased to announce the addition of Dr Michael Corkeron as key note speaker, who will be presenting a number of sessions on The Accidental Intensivist.

Steering Committee members have kept a strong focus on providing very practical information and hands on workshops around contemporary issues facing GP anaesthetists.

“In many areas of rural and

Delegates visit the LMA Pac Med Display at Anaesthesia 2012

regional Australia there is not sufficient demand to justify a permanent position for a specialist anaesthetist leaving GP anaesthetists’ with a special role to fill this gap. The GP registrar anaesthetist model is very successful and it means that people in rural and regional areas do not have to accept second rate healthcare. However it is critical that GP anaesthetists are well supported in their important role” said Conference Convenor Dr Tim Francis.

“GP anaesthetists can suffer isolation and challenges in terms of updating training – it can be very difficult for them to update their skills, which is why this event so important and so well received,” he added.

“This is the third Anaesthetics conference organised by NCGPT since 2010 and we are very proud of the role we play in supporting GP Anaesthetists from around the country through these conferences” said NCGPT CEO

John Langill.

“Our biennial event has a history of excellent programming and presenters, strong academic content, hands on practical training and great venues” said NCGPT event organiser Amanda Shoebridge.

This conference is open to all anaesthetists, and will be of special relevance to GP anaesthetists, GP anaesthesia trainees, their supervisors and associates working in provincial practice. To register or for further information please go to: http://wired.ivvy.com/ event/CDEAYZ/ a CPD points will be available and delegates will be eligible to apply for procedural training government assistance grants.

For enquiries, please contact Amanda Shoebridge on 02 6681 5711 or amandas@ncgpt.org.au North Coast GP Training is the Commonwealth funded Regional Training Provider delivering the Australian General Practice Training and Prevocational General Practice Placements programs on the north coast of NSW.

Chronic pain resources now online A new website has information and resources for both consumers and health professionals interested in the most up to date information on chronic pain. It’s an initiative of the Agency for Clinical Innovation (ACI).

Dr Chris Hayes from the (ACI) Pain Management Network explained that chronic pain is pain that persists for more than three months or beyond the usual time for tissue healing.

In 2011 the Minister for Health launched the NSW Pain Management Plan which outlined a series of actions to improve pain management services in NSW. The ACI was given the task of developing evidence-based resources including free on-line learning modules and fact sheets for consumers and healthcare professionals working in practices and the community.

working in partnership with their health care professionals to better understand their pain and how to reduce it,” he said.

The ACI website builds on the latest knowledge on how to manage chronic pain. It contains:

“The overall aim has been to empower consumers and healthcare professionals with the latest scientific knowledge to understand chronic pain and how to better manage it,” Dr Hayes said.

The ACI partnered with Chronic Pain Australia and the University of Queensland to conduct a needs analysis on consumer resources and worked with Medicare Locals to adver-

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tise opportunities for people with chronic pain to provide input.

This research identified the solution was to develop an integrated chronic pain website. Dr Nigel Lyons, Chief Executive of the ACI said the website offered practical tools and resources.

“It also contains inspiring personal stories of how lives have changed using the selfmanagement strategies and

Interactive learning and for adolescents with chronic pain Online resources to help retrain the brain’s response to chronic pain Inspirational videos Practical tools and resources A health professional toolkit, factsheets for patients and information on NSW Pain Clinics.

Visit the Chronic Pain website at: www.aci.health.nsw.gov.au/chronicpain 27

Family Planning’s wide range of services Clinicians and staff at Family Planning in Lismore and Kyogle are keen to publicise the many services they offer for women and couples of all ages.

The team at Family Planning has a long history of working with women and men of all ages, addressing a range of sexual health issues, with staff building a bank of invaluable knowledge and experience.

Sexual health physician Dr Christine Read joined Dr Kerry Stanwell and Dr Gillian Smith at Family Planning in 2011. She also works for Women’s Health Matters in Lismore. The role of sexual health physician is a relatively new speciality and Christine specialises in the reproductive health issues.

Christine has enjoyed a distinguished career and was one of the first doctors in NSW to take up sexual health as a specialist status. Before moving to the North Coast she was the medical director of Family Planning NSW. She has been working towards removing the inequities between rural and non-rural areas and access to health services and in 2001 established a rural family planning health service in Dubbo.

Back, from left: Dr Kerry Stanwell, Dr Christine Read, Andrew Brooks; front from left: Dr Gillian Smith, Robyn Colliss and Jen Ireland.

“It is important for all women, especially young women, to be in tune with their reproductive and sexual health needs. Sexual health is a critical part of a person’s well being,” said Christine.

“Now sexual health has been recognised as a specialty, it shows that it has become an important area of medicine.”

Family Planning is also keen for more young people and young couples to access the Lismore and Kyogle clinics. The service is free, if you have a Medicare card you can be bulk billed.

The range of services includes:

Contraception including insertion of implants Fertility management Managing menopause Vulval and vaginal problems Incontinence Cervical screening PMT and period problems Women with a disability – management of menstrual and reproductive health issues Counselling and assessment about sexual health issues.

All the Family Planning doctors encourage young couples who have questions to come and make an appointment.

“In rural areas with small towns, managing sexual health can be challenging for young people and they want to keep their confidentiality,” said Christine.

“People should come and see us because they want answers to questions that are difficult to ask.

The more embarrassed someone is to ask, the more interested we are to help them. Sometimes the answers are very simple.”

For an appointment with Dr Christine Read, a referral from a GP is required.

Clinic times

Lismore – Level 3/29 Molesworth Street. Phone 6620 7660.

Monday from 9am to 5.30pm, Thursday 3pm to 7pm and Saturday 9am to 12.30pm.

Kyogle – Kyogle Community Health Centre, 199 Summerland Way. Phone 6630 0488. Fortnightly on a Friday from 9.30am to 1pm (drop ins are welcome between 9.30am and 10.30am).

To find out more, phone Lismore Family Planning Service on 6620 7660.

First birthday for Vaccination Supporters group A little over 12 months ago HealthSpeak learned that a grassroots group of concerned mums and dads and grandparents had decided to set up an organisation with the aim of increasing vaccination rates in the Northern Rivers.

The Northern Rivers Vaccination Supporters (NRVS) came about through social media links. As well as concerned parents, the group includes GPs, surgeons, ICU specialists, science researchers, virologists, epidemiologists and immunisation experts.

The Northern Rivers region has the lowest immunisation rates in Australia. In one town, Mullumbimby, fewer than 50% of children aged two to five years have had their routine

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childhood vaccinations.

With a motto, ‘Love. Protect.

Vaccinate’; the group has adopted a positive approach and hopes to open a dialogue with people who are confused or hesitant about vaccinations.

One of the organisation’s founders, Heidi Robertson, said while Northern Rivers Vaccination Supporters wanted to try

to increase vaccination rates to a more acceptable level, they wanted to achieve their aims in a non-confrontational manner.

“We don’t want to engage in so-called debate on the issue.

We believe there is no debate to be had when it comes to vaccination – the science is in as much as the science is in on climate change and the Earth being round, not flat,” Heidi said.

A big part of the organisation’s role is to provide reliable factual information on vaccination, and through their website list credible links to particular topics and evidence.

The group has had a lot of positive feedback since it began.

“People say they are so happy that a group like ours has been

HealthSpeak

set up to try to counter the misinformation out there,” Heidi told HealthSpeak.

Not unexpectedly, the group has also been attacked by antivaccination supporters through social media.

“But we just ignore that and don’t engage. We keep our message positive and don’t want to waste time on such people.

“The staunch anti-vaccination people are not going to have their minds changed by a group like ours, so we’re more interested in talking to parents who are sitting on the fence and would like reliable information about their particular concerns.”

Visit the website at: www.northernriversvaccinationsupporters.org

A publication of North Coast Medicare Local

winter 2014

Constant innovation enhances outcomes NCCI’s Stephen Manley, Deputy Chief Radiation therapist based in Lismore has a new title – Acting Cancer Systems Innovation Manager, with a focus on improving systems to provide the best care possible for cancer patients across Northern NSW Local Health District.

The role has been established by the Cancer Institute NSW and NNSW LHD to implement the NSW Cancer Action Plan at a local level and improve the outcomes and experiences for people with cancer. This approach encompasses a number of projects and activities – just a few were presented recently by Stephen at the annual North Coast Cancer Conference in Byron Bay where multidisciplinary clinicians from across the mid and north coast of NSW and beyond came together to learn and share collaboratively.

Telelink Telehealth and video conferencing are being used widely to save travelling time and enhance patient outcomes through multidisciplinary telelink meetings (linking numerous sites across the health districts) to discuss a particular patient’s holistic needs.

Stephen said that Radiation Oncology was using video conferencing to provide initial and review consultations across the region.

“For example, patients presenting in Lismore are seen by the radiation oncology registrar who is able to collect clinical information and perform a clinical examination if necessary before discussing the patient’s case with the consultant, Associate Professor Tom Shakespeare.

“Data including referral correspondence, diagnostic results and images are viewed in real time and the patient completes the consultation via video conference. Patients may also meet face to face with the consultant if they wish,” Stephen explained.

Palliative care patients are also benefiting from videolink, allowing them to consult with the Senior Palliative Care clinician

NCCI Innovation

The purpose built North Coast Cancer Institute building in Lismore.

Palliative care patients are benefiting from videolink to consult with Dr Ken Marr.

RT immobilisation devices

employed in the public sector across the Northern NSW Local Health District, Dr Ken Marr.

“This saves these patients the trouble of travelling to see Dr Marr when they are very unwell.

A Grafton-based Clinical Nurse Consultant has been provided with a laptop to allow her to visit the patient in their home or care facility and then tele-link with Dr Marr regardless of his location,” said Stephen.

Data sharing The Reporting for Better Cancer Outcomes program is a partnership between the Cancer Institute NSW and the states Local Health Districts and provides locally relevant data and analysis on surgical activity, cervical and breast cancer screen rates, clinical trials activity and other population-based data that can be used to target systems improvement projects.

The program has resulted in two Aboriginal Health improvement projects – on the Mid

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North Coast Closing the Gap and improving screening rates and on the North Coast improving education and screening rates in Aboriginal communities.

Stephen said the projects had resulted in the development of culturally appropriate resources and an improved awareness of the cancer services provided locally.

“Key achievements included improved engagement with Aboriginal communities, new collaborations, an increase in the number of Aboriginal women taking up mammograms and pap tests, and the commencement of education and screening days – examples being Walk the Talk with the Mob and the Men’s Screening days.”

Stephen said it has been found that giving Aboriginal men and women different places to congregate to discuss specific information had made support groups like the Men’s Shed more comfortable places to gather.

feature

Cancer Registry A team of five staff based in Tweed Heads, Lismore, Coffs Harbour and Port Macquarie (with a program manager who travels regularly to all sites) ensures best practice in the collection and uploading of cancer data to the Clinical Cancer Registry. This information is vital to enhancing local cancer treatment and outcomes.

Telelink has proved a great tool for this team in sharing, building cohesion with the team and allowing more effective education and quality assurance activities.

In addition to the data collection functions of the team are a range of systems improvements aimed at enhancing the range and quality of the data collected.

These projects will enhance the care provided to patients as more information is available to different clinicians at the point of care.

Radiation Oncology Practice Standards NCCI’s Radiation Oncology service has a strong focus on quality management and a project team was set up in 2011 to review and improve these to meet the recently published national Radiation Oncology Practice Standards. NCCI has now demonstrated conformity with standards and believe they are the first centre in Australia to have done so. Stephen noted that conformity with the standards had been achieved voluntarily and without additional resourcing.

One key activity within the project was to enhance the clinical incident management by coding to record actual and near miss events with greater detail.

“Actions resulting from the team’s work include changes to our quality checking processes to remove redundant checks and changes to the coding system to identify when an error has passed through quality checks that are supposed to pick them up.

“We now have three full years of codified data allowing us to Continued page 38 29

CVD deaths fall, dementia on the rise Deaths from heart disease have fallen steadily since 2003, while deaths from dementia and Alzheimer’s disease continue to increase, according to figures released by the Australian Bureau of Statistics (ABS).

“Heart disease is still the leading cause of death, with 20,046 deaths in 2012, however this has fallen steadily since 2003. Heart disease accounted for 14 per cent of all deaths in 2012 compared to 19 per cent of all deaths in 2003," said James Eynstone-Hinkins, ABS Director of the Health and Vitals Statistics Unit.

“There were 10,779 deaths from cerebrovascular diseases (including haemorrhages, strokes, infarctions and blocked arteries of the brain) in 2012, making these the second most common cause of death.

“Dementia and Alzheimer’s disease was the third leading cause of death, accounting for

Causes of Death 2012 1 Ischaemic heart disease 2 Cerebrovascular disease 3 Dementia/Alzheimer’s disease 4 Lung cancer 5 Chronic lower respiratory disease 6 Diabetes 7 Colon/rectum cancer 8 Blood and lymph cancers 9 Urinary system diseases 10 Heart failure 10,369 or seven per cent of all deaths in 2012. Most (95 per cent) of these deaths occurred in people aged 75 or over.

“For women, dementia and Alzheimer's disease has overtaken cerebrovascular diseases as the second leading cause

Review The ALMA Lifetime Eating Plan

By Professor Garry Egger, with Anja Sussmann, Sebely Pal, Joanna McMillan and Shivaun Conn The Australian Lifestyle Medicine Association (ALMA) has devised an eating plan, not a diet book, but a guide for improving health and the environment in the modern world. It’s based on an anti-inflammatory lifestyle.

The authors include some of the most experienced health and nutrition specialists in the country. They explain that this ebook is based on recent scientific findings relating to the body’s evolved reaction to certain foods. The eating plan is focused around a newly discovered form of inflammation (in the organs and arteries of the body) which can lead to long-term chronic diseases like type 2 diabetes, heart diseases and cancers.

The principle is that humans 30

have evolved over hundreds of thousands of years with certain foods and food types, to which their immune systems have adapted.

It’s only since the industrial revolution, but more so since the technological revolution beginning about 50 years ago, that newly developed foods have been introduced into the human diet. As with new bacteria, viruses, or other micro-organisms that come face-to-face with our immune systems, new foods cause a similar immune reaction.

It’s recommended that certain foods be eaten freely or minimally and the authors say such a

Heart disease remains the leading cause of death in Australia.

of death in 2012, while breast cancer remained the sixth most common cause of death.

“For men, lung cancer remains the second leading cause of death. Dementia and Alzheimer's disease is now the fifth leading cause, replacing prostate cancer which is now ranked sixth for males.

“Suicide was the 14th most common cause of death in 2012 overall, but remains the 10th leading cause for men. Suicide

lifestyle will restore your natural body weight and optimal health, while also benefiting the environment. They stress that this e-book should not be read rigidly and that there is no need to stick to a dietary regimen.

Using the principle of ‘do no harm’, the authors say the eating plan may have a positive impact on chronic disease and there is even stronger evidence that it can help change the composition of micro-flora (bacteria) in the gut from an unhealthy to a healthy balance, as well as reduce blood pressure, blood sugars, cholesterol, inflammatory markers and other disease risk factors.

The e-book comes with tasty sample recipes, weekly meal plans and suggestions for other good health behaviours.

Combined with the lifestyle changes, possible supplements and medications referred to in this book, and within the limitations of our genetics, the authors say that the indications are that this will deliver optimal health in a less than optimally healthy world environment.

E-book available for $14.95: www.lifestylemedicine.com.au

HealthSpeak

is the leading cause of death for males and females aged between 15 and 44.

“Overall, the death rate for Aboriginal and Torres Strait Islanders was double that of non-Indigenous Australians.

The leading cause of death for Aboriginal and Torres Strait Islander people was heart disease, with diabetes ranked as the second leading cause.” said Mr Eynstone-Hinkins.

Further details can be found in Causes of Death in Australia at http://www.abs.gov.au/ausstats/ abs@.nsf/cat/3303.0

Access to Hearing Services Program A new website will help thousands of people with hearing loss receive the support they need sooner by making it easier to find information and apply for services.

The website gives eligible Australians better access to services available through the Australian Government Hearing Services Program. With just a few clicks, people can check their eligibility and apply for services online.

Launching the website, Assistant Health Minister Fiona Nash said managing information electronically would cut red tape for clients and providers.

One in six Australians experience hearing loss.

For more information visit: www.hearingservices.gov.au

A publication of North Coast Medicare Local

winter 2014

Reducing Greenhouse Gases – which way is best?

The overall economic effects of an ETS are similar to a carbon tax. The costs of polluting will rise. Some emitters will pass the cost on while others will prefer to cut emissions. The cheapest options will be chosen first.

Under an ETS, the government issues permits to pollute up to a target maximum.

These permits can be traded in the market and the market determines the price i.e. the government sets the volume of emissions and the market sets the price – the opposite of a carbon tax.

While this gives certainty to the volume of emissions, it creates some uncertainty about the price.

When an economy is growing strongly, the price of permits will tend to rise. In a weak economy the price may fall – as happened in Europe during the GFC. The winners will be the government if it auctions the permits, the economy which will see pollution reduced at the lowest possible cost, the owners of permits who will be able to sell them. Losers will be consumers and producers, where the cost of the permits will be passed on.

Both the carbon tax and an ETS are technology neutral in the sense that the market determines the best way the reduce emissions.

Australia has one, but it is under review. Currently, by 2020, 20 per cent of Australia’s electricity is to come from renewables.

This is not the lowest cost way of reducing emissions but it does give support to infant renewable industries that will hopefully allow them to grow and reach economies of scale that will see costs drop sharply.

This is already happening.

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a price to carbon emissions and policies that are technology based.

Most of these policies, if implemented properly, will cut emissions. But the costs can be vastly different. There will also be different winners and losers.

The current Federal Government’s preferred approach is a direct action scheme that will subsidise polluters to change their ways.

It will conduct an auction where polluters say how much they will need from taxpayers to adopt new technologies that will cut their pollution by a given amount.

The Government will pick the winners.

While this may allow the cheapest options to get the nod, the effects are limited.

No price signals will come from the exercise, as energy prices will not change.

The only reductions that will occur will come from the polluters chosen by the government.

In an economy that is growing it is probable that GHG emissions from the rest of the economy will increase – offsetting any good the Government has done. To avoid this the Government will either have to introduce strict regulations to limit new emissions (red tape) or expand the subsidy scheme.

The winners will be the lucky polluters who can reduce emissions at no cost to themselves and society - if climate change is slowed.

The losers are taxpayers.

Technology Specific Policies

Renewable Energy Target

Carbon Tax

A carbon tax aims at increasing the cost of GHG emissions - and so encourage emitters to look at different ways of doing business.

Some will decide it is too hard and will simply bear the extra cost or pass it on if they can.

If so, the higher costs will give everyone - individuals, corporations and governments - some incentive to reduce emissions.

Others will find it cheaper to change rather than pay the tax.

This makes the tax an efficient way of reducing emissions – the market determines the cheapest way.

The disadvantage is that there is no certainty by how much GHG emissions will be reduced because the tax sets the price of emissions and the market determines the volume. Setting the right tax level is guesswork.

In an economy that is rapidly growing it is quite possible that GHG emissions will increase. The winners will be the government that collects the tax and the broader community that gains from a reduction in climate change.

The losers are consumers and producers who bear the cost. The worst hit will be the poorest in the community and they would have to be compensated.

So will some workers who lose jobs in polluting industries. These losses will be offset by new jobs with green energy producers.

ments adopt policies that have the lowest cost.

So what are they? The range of policy options is vast.

They range from carbon taxes and emission trading schemes to direct regulation, tax incentives, direct subsidies, renewable energy certificates, feed-in tariffs and renewable energy targets.

Economists reckon that these policies can be divided into two main categories: those that attach

direct action

Australia’s GHG emissions by at least five per cent below 2000 levels by 2020.

The main disagreement is on the methods used to bring this about.

Government intervention is necessary because without it, the private sector can emit GHG for free.

Because the task of bringing GHG under control is so immense it is essential that govern-

Emissions Trading Scheme

The latest report from the IPCC (Intergovernmental Panel on Climate Change) has once again warned of dire consequences if humanity does not urgently reduce the emission of greenhouse gases (GHG).

It comes at a time when Australia is once again about to be immersed in arguments about the best policy response. Both the major political parties claim they are committed to reducing

Economy David Tomlinson

These can take many forms including car emission standards, feed-in tariffs for solar panels, green energy targets, and insulation standards for buildings.

These can be effective in terms of cutting GHG emissions but not necessarily at the lowest cost.

In practice many countries adopt a variety of approaches – often more politically motivated than economically based.

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Living with epilepsy and stroke

By Gary Southey I was the Executive Officer for the Tweed Valley General Practice Network for nine years and employed there for 15. I was also on the Board of Directors of North Coast GP Training for five years and was also prominent in the development of North Coast Medicare Local.

In March 2012 I was attending a refresher course for the Australian Institute of Company Directors in Sydney.

The first day was nearly over and I was looking forward to the following day as we were to discuss the Governance structure of Medicare Locals. The next thing I knew I woke up surrounded by two paramedics. I had had my first seizure. Questions were fired at me; I hope the answers made sense.

My wife Melinda was called as they wanted more information.

I was loaded onto a stretcher and taken to Royal Prince Alfred Hospital. I must say that despite the seriousness of it all, it was quite embarrassing being wheeled through the foyer of the Hilton Hotel.

After various scans and consultations with doctors and specialists, it was revealed that I had an Arterial-Venous Malformation (AVM) n the brain - a problem where an artery joins directly into a vein. Apparently it was a big one.

My wife made it down to Sydney the next day and we weighed up the options. We had three: stereotactic radiotherapy, brain surgery, or do nothing and risk a large cerebral bleed.

We went with option two. The surgery was booked for June and I returned to work.

Unfortunately a week after lengthy surgery to remove the AVM, I had a stroke. I required further surgery and was in a coma for four weeks, ICU for five weeks and in hospital for three months. I now have a disability. I was transferred to the rehab unit at Murwillumbah Hospital and continue to attend speech therapy there as an outpatient.

The stroke and epilepsy have affected my temporal and parietal lobe in my brain and my speech therapist says I have a high level cognitive language deficit. This deficit becomes more severe fol-

Epilepsy is a horrible thing to have. I cannot drive until I am seizure free for 12 months

lowing seizure activity.

I have reasonably good auditory comprehension with some mild deficits in processing of lengthy and/or complex information. I have mild expressive aphasia, a disturbance of the comprehension and formulation

Indigihealth International seeks writers An Aboriginal physiotherapist based on the Gold Coast has launched a blogazine, Indigihealth International, to explore Indigenous health issues with a world perspective.

Ray Gates is a Bundjalung man who’s been involved in Aboriginal health for 20 years. He says he launched the blogazine to encourage collaboration.

“The irony of Indigenous health is that we have one of the smallest groups of people tackling one of the largest issues in modern society. It’s so big that none of us can deal with it in isolation.

“We need to work together: doctors with nurses and allied health professionals, health professionals with service

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A snapshot of the Indigihealth website.

managers, policy makers, and community leaders, the health industry with education, social services, social justice, and infrastructure,” he said.

Indigihealth International will happily publish any article, be it a news story, an opinion piece, a profile on a profes-

sion, project, or service, a policy update, a book review, or whatever else, as long as it is relevant to Indigenous health.

To read Indigihealth International, go to www.indigihealth.com. And to submit an article, email: submissions@indigihealth.com

HealthSpeak

of language caused by dysfunction in specific brain regions.

This is characterised by word finding deficits in conversation.

I also have great difficulty using complex written language, but I get there.

This is all quite frustrating.

I know what it is I want to say but I just can’t find the words at times. Added to this are my antiepilepsy medications designed to slow the brain. Believe me they work, which makes me more frustrated.

Epilepsy is a horrible thing to have. I cannot drive until I am seizure free for 12 months (another 50 weeks to go), I average one every four to six weeks despite the medications. I cannot swim without supervision, use power tools etc. These seizures can last for anything from five to 30 minutes and leave me extremely tired for up to a week.

I have been admitted to hospital on two occasions as a result. I have had ringing in my ears and not been able to speak for three days until this resolved. Again, very frustrating.

Having speech and cognitive difficulties also makes me feel stupid. Numbers completely throw me. Yet, for 15 years I prepared budgets and tracked program expenditure. Putting the date on a Medicare form would seem to be simple, yet for me it becomes so complex.

Will I return to work? I don’t know. I’d like to think I can. I read a lot regarding neuroplasticity and the brain’s ability to adapt and change. It is fascinating. I am an optimist and anything is possible. I try to keep my brain active, I read the newspaper, books, play scrabble, continue with speech therapy and do my brain injury training program online. I can only keep trying.

A publication of North Coast Medicare Local

winter 2014

A Trip on a Pirate Ship A friend who visited Bali remarked the thing most noticeable on returning home to Australia; there is no smell, a sort of reverse culture shock.

That smell of Asia, a sweet and sour mixture of sewage and cooking, fish sauce, drains, live pigs, chickens and cows is overlaid by a haze of exhaust fumes from smoky tuk-tuks trucks, rickshaws and a nuance of general overcrowding. More often than not, this pot-pourri ferments in the unrelenting heat and humidity of tropical conditions.

I was reminded of this arriving in Kuta one day not so long ago, then the same day moved away from these land smells to a sailing ship, setting out that night for Lombok on a 10 day voyage in an easterly direction.

I was on board Al likai, which means ‘Queen of the Sea’.

A crew of 10 Bugis men who run the ship don’t seem to have regular bunks, but live on board permanently. Traditionally the Bugis were pirates in these waters, so feared that Dutch mothers threatened naughty children with the bugi-man. Because the crew are this pirate stock, all on board felt very safe The ship is a wooden phinisi, a gaff-rigged hundred footer, black like a pirate boat. A modern re-fit has made 12 cabins, air-conditioned with ensuite and lashings of hot water thanks to an on-board desalination plant.

The main daily event was snorkelling over wonderful coral in tropical water; so clear it was like floating in air. As an Aussie, I realised only then how relaxing was the background knowledge - there is no shark danger in these waters.

My reason for joining the

voyage was to order and transport medical supplies to Bali to equip the ship. Hospital emergency departments have great cupboards to research best supplies in first aid and a few hours with Dr Paul Fisher FACEM was most helpful in my task.

My other responsibility, training the crew in first aid was put to the test when the doctor sustained a minor wound on a deserted atoll. The ship was anchored a mile away and I had no way of communicating. I was lucky it was not major, but valuable lessons were learned that day in the ‘S’ of DRSABC (Danger, Response, Send for Support, Airway, Begin CPR, Continue Compressions until relieved or unable to continue).

Communication between the ship and anyone ashore is by walkie-talkie, a relatively modern device for the crew.

This area of sea turned out to be extremely remote, miles of coconut island beaches with no inhabitants outside small clusters. After that we always remembered the walkie-talkies.

There were a couple of considerations about what to include or not in the medical stores. Some of the passengers have risk factors and hands on medical help may be three days away.

Cardiovascular events, drowning, burns, asthma, allergy and even acute psychosis were all possibilities, Dr Fisher had reminded me at briefing.

A medical teacher once remarked that ’common things occur commonly’. So the kit included pads, bandages, splints, tape and boxes of dressings with lots of iodine for coral cuts and drops for tropical ear.

All in all, it added up to two suitcases totalling 40kg. Indo-

HealthSpeak A publication of North Coast Medicare Local

winter 2014

nesian Customs officers were perplexed but seemed satisfied by a mysterious explanatory letter from the harbourmaster, written in Bahasa, which I was fortunately carrying.

The owner of the Al Likai is an Australian woman called Amanda. She travels with each voyage, which can last seven to 20 days. She has undergone an intensive training course in marine first aid run by Dr Gerry Fitzgerald through the RYA and so the equipment was locked under her care. She has access to helplines in Bali and Australia.

The next voyage after I left had a nurse on board who was able to help an asthmatic passenger with medicines and oxygen, also carried on board.

Light Airs David Miller

A medical teacher once remarked that ‘common things occur commonly.’

www.indonesianislandsail.com

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Paediatric OT focuses on results Erika Stevenson has opened a new practice as a paediatric occupational therapist in Port Macquarie.

Erika focuses on setting goals with parents and children so the child acquires particular skills in order to enhance daily activities. Her services are available for individual children, groups or in school settings.

Erika uses Superkids Occupational Therapy (OT) which is child-centred and based on the assumption that the child and their family will be active participants in the process.

Superkids OT is based on the Cognitive Orientation for Daily Occupational Performance (CO-OP) model, the world’s best practice cognitive approach. This means that factors such as performance skills (motor, process, communication and interaction skills), patterns (habits, routines and rituals), activity demands and client factors (body structures/ functions) are only considered if required.

CO-OP enhances the acquisition of skills, enables engagement in relevant occupations

We work in ways directly relevant to the child’s circumstances and promotes participation in daily activities. It is a problem solving approach in which child (or child and parent) specified goals are addressed from a learning perspective.

Erika explained how COOP works: “We think about the tasks that the child wants or needs to perform rather than foundational skills. This means that we work on a task like riding a bike in the child’s role as a playmate, rather than working on improving balance or bilateral coordination.

“We work in ways directly relevant to the child’s circumstances with active engagement of both the child and parent at all stages, and any intervention is both flexible and tailed to the individual child,” she added.

Superkids OT provides a

range of services within the CO-OP framework: Handwriting assessment and intervention Anxiety management Gross and fine motor assessment and intervention Visualperceptual and visualmotor assessment and intervention Self-care intervention (dressing and organisation) School readiness assessment and intervention for preschoolers Social skills training Erika said that Superkids OT always takes into account the child's particular likes and needs when drawing up a program.

“It’s important to listens and respect what children have to say, focus on their needs, see things from their perspective and views them as individuals as well as members of a group.”

Erika also offers group classes in gross motor skills, fine

Erika Stevenson

motor skills, school readiness, handwriting and pre-writing (ABC) classes, and a social skills class to help children fit in at play. A children’s yoga and relaxation class is also available.

Rebates are available for those in private health funds and Erika is a registered Medicare provider.

For more information, phone Erika on 0407 652 472.

North Coast parenting e-course Parentshop has released an online parenting course to help parents of two to 12-year olds manage difficult behaviour.

Based on psychologist Michael Hawton’s book of the same title, Talk Less Listen More, the e-course is a 15 short episode video series that provides parents with a method for setting things up differently at home. The core elements include helping children develop self-control and instructing parents to use calmer approaches to managing difficult behaviour. The cost of the ecourse is $139.

Michael says that as a former teacher he recognises that when children are more self-disciplined they learn better.

“For many parents getting good quality help can be a problem, particularly in rural areas. That’s 34

where I believe our e-course will be useful. Having worked closely with psychiatrists and paediatricians, I am sure this e-course will provide local doctors with an important resource to help parents manage children’s behaviour.”

GPs and allied health workers can preview the e-course firsthand for free if they wish. Simply contact Kelley at communications@ michaelhawton.com to arrange a temporary password.

The course has recently been

Michael Hawton and his book

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watched and reviewed by a number of child and family specialists, including the one below from child psychiatrist Dr Toula Tsovolos.

“I often see children who display difficult behaviour at home, and it can be tricky for parents to know exactly how to respond without escalating into arguments, negotiating and yelling. This e-course explains three ‘do-able’ alternatives to managing oppositional behaviour.

It’s packaged simply – but not dumbed down – and it follows a clear sequence of lessons. It could be applied to children with special needs, as well as children who have developed a pattern of misbehaving.”

To find out more, go to: www.parentshop.com.au

A publication of North Coast Medicare Local

winter 2014

Books with Robin Robin Osborne

Plague and Cholera Patrick Deville Little, Brown An intriguing coda to this prize-winning novel comes not in the work itself but in a recent report in The Guardian, although citing it so early in the review might suggest it negates the book’s veracity (the jury is still out) and consequently the reader’s enjoyment (which it doesn’t).

The focus of the tale is the French doctor, bacteriologist and general Renaissance Man Alexandre Yersin, a Louis Pasteur protégé, whose research work on the bubonic plague led to its receiving the scientific name of Yersinia pestis.

While circling back to his earlier life, both in Europe and later Hong Kong, where he made his plague vaccine discovery, the story begins in Paris in May 1940.

Some 46 years after cracking the ‘Black Death’ and the cause of its spread - fleas from infected rats biting humans - Yersin is boarding a plane bound ultimately for that part of French Indochina now known as Vietnam.

Like so many others, he is fleeing in advance of the Nazi occupation, although unlike most he speaks that language fluently, having been largely educated in Germany.

When studying there, “He buys from Carl Zeiss the very latest microscope, which will never leave him subsequently, accompanying his global travels in his baggage, the microscope that, ten years hence, will help him identify the plague bacillus.”

The famous doctor is returning to the place where he HealthSpeak A publication of North Coast Medicare Local

winter 2014

explored unmapped territory, championed the propagation of the rubber tree, and the cinchona for making quinine, established a wireless telegraphy system linking key Vietnamese centres…

“When the Academy of Sciences awards him a prize for some clever brainwave, he invests the money in building a winding road thirty kilometres long. He becomes a civil engineer.”

Now, he is fleeing his homeland for what he hopes will be safety in old age.

“The gangway is being pushed against the fuselage from the left, because the early aviators, Yersin among them, were also horsemen,” writes Patrick Deville, a French cultural attaché and acclaimed writer, in one of the historical observations that pepper this work and make it so enjoyable.

“The aircraft shudders and soars into the air. Brows are mopped. This will be the last flight operated by Air France for some years. No one realises that yet.”

Yersin is no stranger to the wider world. Back in 1890 he had enlisted as a ship’s doctor on a Messageries Maritimes liner bound for the Far East. His posting was the Manila-Saigon run.

In the Asian country that further fuels his passion for discovery he meets Albert Calmette, a widely traveled navy doctor who, like him, was another “boy in the Pasteurian crowd.”

He has come to Saigon to establish a local branch of the Institute, a posting that will prove historic. Reflecting on their first meeting, over drinks at the Majestic Hotel, Yersin recalls what Calmette had talked of.

“Studying the alcoholic fermentation of rice, the analgesic effects of opium, using venoms to cure otherwise fatal snake bites.

“Calmette was successful, that we know. When, later, the BCG vaccine is named, the central ‘C’ will be his initial. Today, there is the Calmette Hospital in Phnom Penh, not far from Wat Phnom and the Pasteur Institute.”

Yersin lived 50 years in the

coastal town of Nha Trang, and in his waning days is visited by two visiting scientists who “look into Yersin’s blue eyes – that once looked into the blue eyes of Louis Pasteur,” as the old man contemplates his mortality.

“Never a Plutarch man, Yersin has not tried to leave his mark on History… Yersin’s life offers no example to be shunned or reproduced, no conduct to imitate.

Here is a man who has steered his life on a solitary course – and done so rather well…At nightfall he is helped back to his desk, where he resumes his studies of Greek and Latin.”

For the locals, however, a different story.

Pasteur, the great mentor, was made a saint of the Cao Dai religion, and Yersin is a Bodhisattva in the nearby pagoda, while Yersin Street crosses Nha Trang’s Pasteur Street, and there is a Yersin Museum with hundreds of his books, and poems by Virgil, typed in Latin with penciled translations and lists of Vietnamese sentences to remember.

A photo of him with pioneering film-maker Lumiere, his last airline ticket, dated 30 May 1940, and another photo, after touchdown, ‘alighting from the little white whale in Saigon.’

Postscript: a recent report claimed that only an airborne infection could have spread so fast and killed as quickly as the Black Death, and that the highly contagious bacillus was not in fact spread by the fleas on rats. http://www.theguardian.com/ science/2014/mar/29/black-deathnot-spread-rat-fleas-london-plague

Bookmark HealthSpeak and read it online HealthSpeak is now online and proving popular with a growing number of readers.

Bookmark it now at: www.issuu.com/ healthspeak

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Make hearing a priority Australian Hearing is spreading the word that hearing should be part of regular health check-ups and general practices are well placed to do this, especially with an improved referral process.

“Research has shown that seniors are misunderstanding their doctors' instructions due to hearing loss and we want to help GPs address this,” says Karina Morrison, Manager at Australian Hearing.

According to research by Australian Hearing, 21 per cent of older Australians say they experience difficulties when visiting their GP due to their hearing loss. As a result of poor hearing, 14 per cent of those surveyed said they felt embarrassed to ask their GP to repeat sentences and 10 per cent find it hard to follow medication directions.

However, 72% who had received advice from a GP or specialist about hearing loss, followed the advice most or all of the time.

Australian Hearing offers general practices a free hearing

check and health program with the option to claim a fee for the Audiology service, if medical services provided are specified under the MBS Audiology Services (D1.12).

Australian Hearing can train practice staff to provide the hearing check service to their patients, which can also contribute to CPD points for nursing staff.

If an eligible patient requires further hearing assessment, the practice can refer to Australian Hearing Audiologists.

The referral process for the Office of Hearing Services Voucher Program has recently changed.

The old green voucher application has been replaced by a Medical Certificate for the GP to sign and refer a patient to hearing services. Australian Hearing will now submit the Medical Certificate to OHS, on behalf of your patient, using the Hearing Services Online portal.

The new system will reduce the waiting time between a

hearing check and hearing assessment, from six weeks to around two weeks.

Interested GPs will receive a Medical Certificate form pad to refer patients to Australian Hearing.

An online form is also available at www.hearing.com.au/healthprofessionals-patients-hearing/ Australian Hearing provides free and subsidised hearing services to eligible patients includ-

ing pensioners, veterans and dependents. Australian Hearing are also the sole hearing provider to provide free specialist care under the Community Service Obligation to children and young people under 26, Aboriginal and Torres Strait Islander people over 50, and adults with complex needs.

You can check eligibility for hearing services by visiting www. hearing.com.au/eligibilty.

All GPs and practice managers are invited to contact their local Australian Hearing team to discuss their practice’s specific requirements and find out more.

Call Australian Hearing on 131 797 or www.hearing. com.au

About Lismore Men and Family Centre The Lismore Men and Family Centre (M&FC) is a non-government organisation that specialises in working with men with abusive and controlling behaviour.

The M&FC also works with women who have experienced, or are living with, violence and abuse; men who have experienced childhood sexual abuse; and anyone who has experienced grief and loss, trauma or is living with depression and anxiety.

The Centre’s Men's Behaviour Change Program, MEND, runs in 16-week cycles for 48 weeks of the year, and men can be referred to the group and enter it at any time.

All participants in MEND are engaged in an extensive Intake interview prior to their entry into MEND. Additionally, the M&FC

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The Men & Family Centre website: www.menandfamily.org.au

runs groups for women who have left abusive relationships, or are finding their relationships difficult, and works to support women whose partners are engaged in the M&FC's behaviour change

program. Its male and female facilitators have wide and experience and knowledge of the dynamics of family violence.

The M&FC is also collaborating with Heartfelt House to deliver a weekly group for

HealthSpeak

male survivors of child sexual abuse. This group works intensively with male survivors in a safe and thoughtful manner that recognises the special difficulties they face.

Counselling is offered through the M&FC for women and men who have experienced abuse and violence, grief and loss and depression and anxiety. Both long-term and short-term counselling is available.

Referrals to these programs can be made by phoning the Centre on 6622 6116, and we encourage anyone with questions to drop into our offices in Club Lane in the Lismore CBD. The M&FC experiences many ‘drop-ins' during the year, and we look to create a welcoming and helpful front of house.

A publication of North Coast Medicare Local

winter 2014

Wine and good health Doctors, saints and the grape What is it about doctors, saints and wine, dear reader?

It is almost as if you cannot talk about one without talking about the others. Perhaps there is something naturally good about all three. Wine’s medicinal qualities are legion, so the association with doctors is natural, and similarly wine is a wonderful social elixir, known to lift the spirits, and what better example of a lifted spirit than a saint? It is said you are known by your associates, so all three must be comfortable in each other’s company. The history of wine of course begins well before Christ in the valleys of Mesopotamia, where the juice of fermented grapes was enjoyed by the roadside. Little wonder wine (and beer) took on so well, given the state of drinking water over the ages. As in Asia today, any visitors were less likely to suffer dysentery from a brewed drop.

Hippocrates, in the fifth century BC, extolled the virtues of wine both as a disinfectant, a digestive, and a balm to the pains of childbirth. Jesus chose wine over, say, bourbon at Cana, and St Timothy suggested to the Corinthians to “use a little wine for thy stomach’s sake”. Dr William Thomas Angove, a general practitioner from the old country, acted on this advice when he planted vines to the north of Adelaide to make wine as “a tonic for his patients” in the late 1880s, and his descendants now make “the Medhyk” (Cornish for Doctor) in his honour. And a fine drop it is too, the (latest and excellent) 2010 vintage a stunner in the McLaren Vale.

Powerful and brooding, a complex amalgam of bitter chocolate and liquorice, it will outlive me for sure.

The history of doctors making wine in Australia was well documented by Dr Philip Norrie in his excellent book “Australia’s Wine Doctors” (1994). In it he notes three of our largest companies, Penfolds, Hardys and Lindemans were established

Chris Ingall

by doctors, and that sixty percent of our crush is undertaken by vineyards established by doctors.

Sobering statistics indeed. So it is that if doctors are absorbed with wine, it must be noted wine is equally absorbed by doctors, as we drink a little over the national average, albeit better tipple than average as well. I would go so far as to say our relationship with the vine could almost be considered symbiotic!

If you want to support these wineries, you can buy from Cullen’s (Dr Kevin), Vasse Felix (Dr Tom Cullity), Moss Wood (Dr Bill Pannell) or Xanadu (Drs John and Eithne Sheridan Lagan) in Western Australia, Lake’s Folly (Max Lake of course) in the Hunter, or of course sip some bubbly from Minchinbury or Houghtons.

The lives of the saints are equally interwoven in the history of wine. After St Timothy came a legion of patrons, including St Vincent of Saragossa and St Urban who are both patron saints of wine, and if you are having a problem defining moderation, you can pray to Saints Bibiana and Monica, the patron saints of hangovers and alcoholics respectively. Something for everyone really. The donkey of St Martin of Tours, patron saint of vintners, discovered the value of pruning the vines and there have been many saints appropriated by regions of the old world. The Loire (St Martin), Burgundy (St Morand), Alsace (St Morand again) and even Belgium (St Armand) enjoy feast days and cathedrals dedicated to these saints.

I couldn’t finish without mentioning the Benedictine monks, and their founder St Benedict of Nursia, who was fonder of abstention than imbibing, though wisely understood prohibition would lead to insurrection in

HealthSpeak A publication of North Coast Medicare Local

winter 2014

You can pray to Saints Bibiana and Monica, the patron saints of hangovers and alcoholics respectively

the monastery. The monks have given us many a fine drop over the centuries, including of course Benedictine, an herbal cognac, itself a wine distillation.

And as a final note, for travellers (including Napoleon’s army) who ventured through the Alps’ passes, there is a wonderful breed of dog with such a marvellous sense of smell it can find people buried in the snow, and then lie over them to keep them warm. Various stories abound, but the one I choose to believe is that they had a small barrel containing wine spirit (brandy) around their necks to revive the sorry souls. They did of course not entrust a mere labrador or kelpie with this task. No, they chose a St Bernard.

Wine Tip

Cellar Tip

As I write, I am being seduced by a B&B, equal parts Benedictine and some airport cognac. I can recommend it to you for any cerebral conniption.

Something to drink by the fire these cold winter’s nights. For this, also look out for any Topaque (used to be Tokay) from the Rutherglen. Still excellent value for money at any quality point.

St Henri is a better Penfolds’ red, and the 2010 vintage was given 100 points by Andrew Caillard MW, ahead of the 2009 Grange. Look out for it, as it is an exceptional drop and is selling fast.

Expect to pay between $70 and 80. Enjoy now and for at least two decades.

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RDAA: Don’t scrap the PGPPP Rural doctors are calling on the Federal Government to immediately reverse its decision to scrap a highly valued general practice training initiative, saying it has played a vital role in attracting many young doctors into rural medicine.

President of the Rural Doctors Association of Australia (RDAA) Dr Ian Kamerman, said the Prevocational General Practice Placements Program (PGPPP) has been a critical part of the training pipeline for rural doctors, enticing many young doctors into general practice and rural practice.

It has also taken pressure off the hospital system by helping to meet growing demand for training places for junior doctors.

General practice is at the frontline of Australia’s healthcare system and the PGPPP has been giving interns and junior doctors a significant opportunity to experience general practice and rural practice – before deciding their future medical career path, Dr Kamerman said.

“Many people don’t realise that newly -graduated doctors must spend the first two to three years of their career training in a larger hospital, usually in a

Trivia What word, extended from a more popular term, refers to a fictional book of between 20,000 and 50,000 words?

2 Hippocampus is the Latin name for which emblematic marine creature?

3 What are the three main colours of the national flag of India?

4 The BSE SENSEX is the stock exchange in which city?

5 ‘The Troubles’ is a euphemistic term for the long-running civil/ terrorist conflicts in which country, notably in the late 1900s?

6 The Bodleian Library is part of which highly regarded university?

7 When an orchestra tunes up before playing, what instrument conventionally provides the initial ‘A’ guide note?

1

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metropolitan or urban area.

“The PGPPP has given these doctors the opportunity to rotate out of the hospital and spend time working as a GP in a general practice or rural practice setting.

“Scrapping the program will put an end to any junior doctor exposure to general practice or rural practice at the exact time they are making decisions on the direction their medical career will take.

“All the hard work of developing a sustainable pipeline of doctor training – taking rural kids through medical school and then into general practice and advanced training to meet the needs of their rural communities – will be wasted in one fell

The communist government of which country was overthrown during the Velvet Revolution in 1989?

9 How many senators make up the US Senate?

10 Which award-winning Australian crime writer wrote Truth?

11 Mexican artist Diego Rivera painted the ‘Man at the Crossroads’ mural on which vast building complex in New York City?

12 In the children’s stories of Thomas the Tank Engine, what is the name of the Fat Controller?

13 Elizabeth Taylor made a fortune from what business aside from acting: Horse breeding; Limousine hire; Perfume; or Vegetarian cookbooks?

14 Podagra is the technical term for which medical condition in humans, often associated with heavy drinking?

8

swoop.”

Dr Kamerman said the PGPPP program has worked wonders in getting more young doctors into general practice and rural practice and that cutting it was false economy.

“Even for those young doctors who choose another specialty after undertaking a general practice

From page 29 compare trends year to year and also between the three NCCI Radiation Oncology facilities,” Stephen said.

Among other things, the collection of such data allows clinicians to provide much more targeted and less

15

Olympic cycling (as at 2012) is divided into what four sections?

16 Prunes are dried what?

17 Asha Bhosle is a star and vocal artist of what film type?

Bollywood/Hindi; Cookery; Horror; News/Documentary?

18 The Law of Large Numbers is a principle which seeks to explain what commonly considered inexplicable?

19 Who wrote the opera Aida?

20 What is the square root of 441?

21 Moon starer’ is a fitting anagram of what specialised profession?

HealthSpeak

or rural practice placement, the PGPPP has at least given them a strong appreciation of the challenges faced by rural patients and rural doctors. Consequently, they will have a much better understanding of their patients’ needs when they see them referred some time in the future,” he added.

Dr Kamerman said the PGPPP had also positioned general practice right alongside surgery and other specialties as being an area of medicine that is just as important for young doctors to be exposed to.

RDAA is calling for the PGPPP to be retained as it is, or at the very least in a similar format, so that junior doctors, rural practices and their communities can continue to benefit from such a valuable program.

invasive radiation therapy to NCCI’s cancer patients.

NCCI are in the process of publishing their achievements and sharing their experiences and processes with other centres and non-cancer service providers where quality improvements can be made.

22

Which Australian billionaire’s personal motto was ‘Never complain, never explain.’

23 Which country has the internet domain .pl?

24 Previously deemed too dangerous, what Winter Olympics event will be open to women for the first time in the 2014 Winter Games in Sochi?

25 Which is the only country in Southeast Asia never to have been colonised by a European power?

A publication of North Coast Medicare Local

winter 2014

more services · quality facilities

From page 22 memory of her Dad, posting them and then making fabric patterns, screen prints and decals out of them. With her fabrics she’s made cushions and other furnishings. She’s also working on a series of character drawings such as the wolf-headed lady, again inspired by her father who did some terrific cartoons and comics.

Joanna is also working on putting together a show of her father’s stuff as a lot of young designers are curious about ‘what these art directors who could draw created’.

And she’s working on a project called Duo with 11-year old Audrey Bush, teaching and mentoring Audrey around creating designs and fabrics.

Managing and working in the Lismore Art Space has been an important development for Joanna. For many years she worked alone and she enjoys coming to the space each day and working alongside others.

She and the other artists at the Lismore Art Space now want to share it with the wider community and people wanting to share creative ideas and projects are invited to come along to the refurbished factory on Wednesday evenings.

For this visual artist, the creative process is central to her health and wellbeing, helping her deal with her health issues, including anxiety.

“If I’m making something I can get lost in the process, it’s meditative.

Otherwise, I’m a very active person and I find it hard to sit still. I find the creativity focuses my mind and allows me to go with the flow and then I’m in my element.

“Whether it’s good and works out or not, it’s the focus that stills me and allows me to get things done. Being able to let go and focus on the moment – a lot of my problems just go away.”

To find out more about the Lismore Art Space and Ms Brown’s Lounge, go to: http://lismoreartspace.net.au/ and http:// msbrownslounge.com.au/

OPEN extended hours Goonellabah pharmacy is now open: •Sports & Orthopaedic Conditions •Treat Spinal Pain with mob/ manipulation and Sarah Key Method •Acupuncture for myofascial pain/ muscle spasm •Gym & Pool rehabilitation •Biomechanical analysis for runners and dancers •Orthotics using Gaitscan Technology •Waterproof casts / braces / splints •Vertigo & Balance Disorders

Monday to Friday – 8.30am to 7pm Saturdays – 9am to 4.30pm Sundays – 9.30am to 1pm

Goonellabah Pharmacy For all your health needs Goonellabah Village, Oliver Avenue Phone 6624 2449

Tony Morley & Emile du Plessis and Associates Physiotherapists MAPA

Lismore & Ballina Free Call 1800 662 125

Picturesque Ballina Female GP Wanted Ft/PT for a busy accredited practice Excellent Remuneration No weekends, but shared on call Dedicated staff and two practice nurses Please call Shannon on 6681 1333 We are not DWS or area of need Dr Steven Stylian – Haematologist and Medical Oncologist Byron Bay Specialist Centre, Suite 6, 130 Jonson St

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.

A/Prof Geoffrey Boyce Neurologist Practising neurology and neurophysiology in Lismore.

Dr Boyce has a full-time neurophysiology technician available to do electroencephalograms with little waiting time. Also nerve conduction studies and electromyography. The practice is Medical Objects friendly and welcomes referrals this way.

Phone the practice on 6621 8245 or email: nrneurol.com.au For more information and links to other sub-specialty groups, view the website at: www.nrneurol.com.au

Goonellabah Physiotherapy Centre Gabrielle Boyce and Associates 581 Ballina Road, Goonellabah Phone (02) 6625 2888 Open Extended Hours

PATHOLOGICAL WASTE DISPOSAL Container Collection/Exchange

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

1. Novella 2. Seahorse 3. Orange, white, green (horizontal stripes, from top to bottom, with a blue spoked wheel in the white stripe) 4. Mumbai or Bombay 5. Northern Ireland 6. Oxford 7. Oboe 8. Czechoslovakia 9. 100 10. Peter Temple 11. The Rockefeller Centre 12. Sir Topham Hatt 13. Perfume

HealthSpeak is the perfect place to let the north coast health community know about your practice, company, rooms for rent or anything at all!

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Display advertising is attractively priced. Simply email the editor to get a copy of our rates at: media@ncml.org.au We look forward to hearing from you.

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14. Gout 15. Road, Track, Mountain Biking, BMX 16. Plums 17. Bollywood/Hindi 18. Coincidences (or unusual events - the law states that they are likely to happen when there are lots of opportunities for such events).

19. Giuseppe Verdi 20. 21 21. Astronomer 22. Kerry Packer 23. Poland 24. Ski jumping 25. Thailand

HealthSpeak A publication of North Coast Medicare Local

winter 2014

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