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December 2016
Regional & Remote Feature + Hundreds of rural nurses speak up + Unique nursing service provides cancer treatment at home + Physiotherapist goes the extra mile for rural patients + The rise of natural medicine and therapies
HealthTimes - December 2016 | Page 09
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HealthTimes - December 2016 | Page 03
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December 2016 We hope you enjoy perusing the range of opportunities included in this Issue. If you are interested in pursuing any of these opportunities, please contact the advertiser directly via the contact details provided. If you have any queries about our publication or would like to receive our publication, please email us at contact@healthtimes.com.au
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The HealthTimes magazine is the most widely distributed national nursing and allied health publication in Australia. For all advertising and production enquiries please contact us by telephone on 1300 306 582, email contact@healthtimes.com.au or visit www.healthtimes.com.au Published by Seabreeze Communications Pty Ltd trading as HealthTimes. ABN 29 071 328 053. Š 2015 Seabreeze Communications Pty Ltd. All right reserved. No part of this publication may be copied or reproduced by any means without the prior written permission of the publisher. Compliance with the Trade Practices Act 1974 of advertisements contained in this publication is the responsibility of those who submit the advertisement for publication.
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HealthTimes - December 2016 | Page 07
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It was one of those fierce summer storms that comes after a week of hot weather. Worst of all, the storm hit the clinic during the night, so nobody realised the roof was damaged.The next day, we found the reception counter drenched. But I was all over it. I got hold of our Officeworks Business Specialist, who helped me organise what we needed to replace. She recommended plastic filing cases instead of cardboard folders, and a wireless keyboard that could be put away each night. And because everything was ordered online before 11.30am, it was delivered the same day.
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HealthTimes - December 2016 | Page 09
Celebrating Nurse Practitioners By Karen Keast
A
s Australia’s first Nurse Practitioner (NP) in hepatology and Western Australia’s first NP, Saroj Nazareth, like many nurse practitioners, is familiar with being a trailblazer. Ms Nazareth, who has worked at the Royal Perth Hospital for 30 years after training in ICU in the UK, was endorsed in 2005 and, with her colleagues, has worked to expand and create a pioneering liver service, now home to one of the largest hepatitis treatment programs in the nation. “We started as a small service. We were looking after 20 to 30 patients and progressively by intro-ducing the NP role and we have done a lot of innovative things, we have brought the liver service at Royal Perth to the forefront,” she said. “We were the first centre in Australia to use telehealth to manage patients in the rural and remote areas, but we had to do it out of necessity - Western Australia is very isolated, Perth is isolated, and Western Australia is half the size of Europe. “You need to find how you can look after your patients, especially in the rural and remote areas.” This year, Ms Nazareth was named the Australian College of Nurse Practitioners’ (ACNP) 2016 Nurse Practitioner of the Year for her outstanding contribution to clinical work, mentoring and lead-ership. With national Nurse Practitioner Day celebrated on December 12, representing the day the first NPs were endorsed in Australia in 2000, Ms Nazareth said the day acknowledges the vital contri-butions of NPs to the health and wellbeing of patients across Australia. Australia is now home to more than 1400 nurse practitioners, working in settings ranging from community health centres to GP
Page 10| www.HealthTimes.com.au
clinics, residential aged care facilities, hospitals, prisons, schools and universities, pharmacies and in private homes. As highly educated, skilled and experienced registered nurses, nurse practitioners can prescribe medications, order and interpret X-rays and blood tests, as well as refer to medical specialists. ACNP president Dr Grainne Lowe said nurse practitioners are equipped with a high level of educa-tion and skills to meet the changing health care needs of Australians.
“The nurse practitioners’ extensive knowledge of health care systems as well as their high level of ability to work as part of health care teams, ensures patients are the central focus of care which improves the quality of life for patients, families and carers.” Ms Nazareth said nurses wanting to reach a new level of excellence in clinical practice should consider pursing a career as a nurse practitioner. “The nurse practitioner is a fantastic role to aim for because you would get personal satisfaction and so much rewards looking at how you can practice and how it actually enhances patient man-agement,” she said. “At the end of the day, you are totally improving patient care which is what we are all looking for.”
For more articles visit HealthTimes.com.au
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Green light for health workforce scholarships The Federal Government will offer a limited round of nursing and allied health scholarships for students next year as it prepares to launch an overhauled scholarship program. Rural Health Assistant Minister Dr David Gillespie said the 12-month scholarships will be offered through the existing scholarship administrators - the Australian College of Nursing (ACN) and Services for Australian Rural and Remote Allied Health (SARRAH). “I want to reassure nursing and allied health students that the Coalition Government will continue to support our best and brightest young minds with their studies next year,” Dr Gillespie said. “Rural and remote health is built on the commitment, the skill, the resilience and the expertise
of its workforce, and we want to support the sector to grow.” Dr Gillespie said the design of the new Health Workforce Scholarship Program (HWSP) is being finalised and will be launched early in 2017. “The new HWSP will increase health workforce participation and promote a better distribution of the health workforce, particularly in rural and remote communities where their expertise and services are needed the most,” he said. “It will also deliver a consistent approach to the rules and obligations that will apply to scholarship participants as well as provide greater flexibility to meet changing workforce priorities in response to local needs.”
For the full article visit HealthTimes.com.au HealthTimes - December 2016 | Page 11
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Seymour Health is seeking an experienced and suitably qualified nursing professional for this exceptional opportunity in a small rural health service which is committed to the provision of high quality care. Candidates will have an approved Bachelor of Nursing or equivalent qualification to enable current AHPRA registration as a Registered Nurse (Division 1) and a minimum 5 years post-graduate experience as a Registered Nurse. Previous experience in a rural health service is desirable. For full details of the role see our website at www.hrsa.com.au or contact Ms Jo Lowday on: 0400 158 155. To make an application you will be required to submit: a Cover Letter, a response to the Key Selection Criteria, your full CV and a completed HRS Application Form available on the HRS web site. Applications can be made online or sent by email to: hrsa@hrsa.com.au Applications close 23 December 2016 PO Box 83 Ocean Grove 3226 hrsa@hrsa.com.au www.hrsa.com.au
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Page 12| www.HealthTimes.com.au
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Midwives Position Status: Permanent Hours Available - EFT Negotiable Classification: RN / Registered Midwife Grade 2 and CNS (YS9) The Registered Midwife will be responsible for, providing high quality midwifery care to women and their significant others in accordance with the organisation’s policies, procedures, clinical practice guidelines, standards and values. Benalla Health is transitioning from a predominately on call model to a Structured Roster model of 8/8/10 with limited weekend on call. Benalla Health is experiencing a growth in antenatal bookings. For more information please contact: Maree Woodhouse, Director Clinical Services on 03 5761 4209. Applications Close: Monday 30th January 2017 at 5.00pm. Application Process: To apply and for full details, please log-on to: benallahealth.org.au/benalla/careers
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HealthTimes - December 2016 | Page 13
Midwifery push to Birthing on Country
A
pioneering Birthing on Country maternity services program will increase and support the Indigenous maternity workforce, expand culturally competent maternity care, and establish primary maternity units. The Australian College of Midwives (ACM), the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), the University of Queensland and the University of Sydney have joined forces to launch the program at the CATSINaM International Indigenous Health Workforce Meeting this week. Birthing on Country involves traditional practices and connection with land and country to ensure the best start to life for Aboriginal and Torres Strait Islander mothers and their babies. The new program will work to close the gap on health inequality with integrated, holistic and culturally appropriate models of care for Indigenous women, families and their communities. Professor Sue Kildea, director of the Midwifery Research Unit in the Mater Research Institute, a collaboration between the Mater Health Services in Brisbane and University of Queensland (MRI-UQ), said the initiative was a major milestone in advancing culturally safe health services for Indigenous women. “We’ve now got funding to progress the Birthing on Country project and I am going to be applying for more NHMRC funding to try and progress this work,” she said.
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“We will be looking at a couple of sites for testing the Birthing on Country framework. We are wanting to work with communities that want to have a Birthing on Country model up and running and tested.” In a report, published in The Medical Journal of Australia, Professor Kildea has reviewed the success of the National Maternity Services Plan (NMSP), which set out a five year vision for 2010-2015. While the NMSP resulted in strengthening maternity services in some areas, the report states it failed to achieve “notable results” in the three priority areas of increasing the Indigenous workforce, boosting culturally competent maternity care, and developing dedicated programs for Birthing on Country. Professor Kildea has called on Australian federal, state and territory governments to fund critical initiatives, such as Birthing on Country programs, to improve maternal and birth outcomes for Aboriginal and Torres Strait Islanders. While the NMSP highlighted the importance of developing Birthing on Country programs for Indigenous women, she said no progress had been made to establish and evaluate Birthing on Country services in remote or very remote parts of Australia.
For the full article visit HealthTimes.com.au
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HealthTimes - December 2016 | Page 15
Hundreds of rural nurses speak up By Karen Keast
M
ore than 700 rural nurses from across Australia have voiced their professional needs and concerns in a CRANAplus survey. As the peak body for the remote health workforce, CRANAplus CEO Christopher Cliffe said the organisation launched the Rural Nursing Survey to identify the key priorities, education and support needs of an under-represented part of the rural health workforce. “Although we are much more about remote health, a vast majority of remote health is provided by remote area nurses, and remote area nurses - where do they come from and where do they go to? It’s rural health so it’s part of the pipeline in and part of the pipeline out. “Many of us actually transition between rural nursing and remote nursing but they are quite different areas of practice. “In rural nursing you are often part of the community, you might come from the community. Whereas, when it’s remote nursing you are often a visitor - you are going in and doing an intensive block of work and then you often hightail it out for a while. “We were getting quite a bit of lobbying from our membership saying - we’ve got all this great stuff for remote health but what about rural health? “The survey was about just asking some simple questions - is there anything CRANAplus can be doing more for you? Can we help you, can we support you, can we educate you better?”
Page 16| www.HealthTimes.com.au
Mr Cliffe said there had been an incredible response to the survey, with more than 200 country nurses completing the online survey in the first 12 hours. “For us, it’s telling us that there’s a need out there, there’s a gap in the market that rural nurses don’t necessarily feel as valued maybe as their remote or urban cousins. “They are a smart, engaged part of the workforce, and they are quite keen to drive some reform, I think.” Mr Cliffe said survey respondents have highlighted a range of issues, from a need to introduce national professional standards for rural nursing to better safety and security. “There was also a vibe across all of it that they are not well respected and they are not well utilised by the medical staff that work in small country hospitals, as well as the management of small country hospitals,” he said. “Every practice is often funded differently. A lot of these patients who come to their small country hospitals, their primary after hours service can very effectively see, assess and manage them either by the nurse or by the nurse in consultation over a telephone call with a doctor. “That’s good for the patient - it’s quick, it’s easy, it’s a good model of care, and it’s also more cost effective, one would assume. But in a lot of places, unless the GP gets called in, the GP doesn’t get paid for that.
For the full article visit HealthTimes.com.au
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HealthTimes - December 2016 | Page 17
Unique nursing service provides cancer treatment at home By Karen Keast
A
registered nurse and a specialist oncology pharmacist are revolutionising cancer treatment, providing chemotherapy and immunotherapy in the comfort of patients’ homes. Lorna Cook and Julie Adams launched their Perth-based private service chemo@ home three years ago. The innovative service has been such a success, the duo now employ 17 mostly casual staff, including nine nurses who administer 300 treatments a month. Lorna and Julie are now planning to expand nationally, beginning in South Australia and Victoria within the next six months, and are looking to employ up to 100 chemotherapy-trained nurses in the next year. Lorna, who began nursing more than 30 years ago and has also worked for a pharmaceutical company in the oncology field, says the service is transforming the provision of healthcare to patients - reducing patient fatigue and risk of infection while cutting patient travel and parking costs, and decreasing patient reliance on carers or childcare. “It makes their lives so much better - their quality of life improves,” she says. “Patients attending hospital quite often develop treatment fatigue and they just don’t want to turn up to hospital any more, especially the elderly, because they have to have a family member take them into hospital.
Page 18| www.HealthTimes.com.au
“Our compliance rates are much better because we are going to the patient’s home and they can stay in their ‘jammies’.” Ms Adams established the now-defunct WA Health Department-funded home chemotherapy service, enabling oncology and haematology patients from several hospitals to receive treatment while at home. Building on her experience and expertise, Ms Adams, who was recently named the WA 2016 Telstra Business Woman of the Year, saw an opportunity to increase the availability of home treatments. “We were both single mums of three children, we mortgaged both our houses to the hilt and we started the company - we started with two nurses and ourselves, and Julie and I worked for free,” Lorna says. “We’ve overcome so many obstacles and we’re doing really well.” As well as treatment for a range of cancers, including breast, colon and lung cancer as well as leukaemia, lymphoma and myeloma, the service also provides infusions for chronic conditions, such as rheumatoid arthritis, multiple sclerosis, osteoporosis, Crohn’s Disease and iron deficiency anaemia, alongside infusions for a range of other conditions. Lorna says most health funds cover the service, with no gap, and more than 80 specialist doctors now refer to chemo@home.
“We manage everything from there - we manage the patients’ scripts, we pick up the drugs from the pharmacy, we check the patients’ blood tests, and ring the patient the day before to make sure that they haven’t got a temperature or anything,” she says. “We also have a nurse on call 24 hours a day in case the patients have any problems, which they rarely do because they have their nurse sitting with them one-to-one for up to two hours during the treatment. “The nurse gives them education, assesses their family life, and if they need any help we have referral systems set up for things like psychologists or social workers. “We even have a physiotherapist that will do home visits and he and his team are particularly focused on treating cancer patients. “We do a complete package of care for the patient while we are there. “The patients are happier. We do quality of life and other questionnaires on the patients and I don’t think we’ve ever even had one negative comment - everybody loves the service and they love their nurses and it’s expanding pretty much on consumers’ demanding the service.” Lorna says nurses carry emergency kits including defibrillators in preparation for adverse events, and the service, now coming up to its 5000th treatment, does not manage high risk patients, who are required to attend in-hospital treatments. “Most of our patients stay with us until either they are finished their course of chemo while most of our other patients stay with us until their doctor decides they can’t have any more treatment. “And we are fully integrated with the hospital system so patients don’t have to choose one over the other, they can go backwards and forwards between the two.” Chemo@home is also partnering with Edith Cowan University (ECU) to conduct ground-
breaking research which will monitor and record the experiences of patients receiving immunotherapy at home. Professor Lisa Whitehead, director of the Centre for Nursing, Midwifery and Health Services Research, says the research will provide valuable data on patient experiences and outcomes from receiving new immunotherapy drugs. “What we are wanting to do is further improve people’s experiences by understanding what symptoms they experience - we don’t know too much yet because it’s quite new therapy, and we don’t fully understand the side-effects and the longer-term side-effects either.” As part of her PhD at ECU, Lorna will also investigate developing a technological solution, such as an interactive app, designed to enable nurses to immediately respond to any changes in a patient’s condition. For Lorna and Julie, who both manage chemo@home, their ultimate goal is to redefine the way patients receive their treatment and care. They hope the service will eventually also be rolled out to public patients. “The government has struggled to do these types of programs economically efficiently. But we can - we have proved it. We’re profitable, we’re expanding and we would love to be able to provide this service to public patients,” Lorna says. “People in lower socio-economic groups, it’s so difficult for them to get to hospital - they find it difficult to get the petrol to put in the car to go there or to find childcare while they have their treatment, and some older people have no-one to take them to hospital. “We would like to see that every patient, who wants to have their chemo at home, can. We envisage that, one day, patients only go to hospital for chemo if they have to.”
For more articles visit HealthTimes.com.au HealthTimes - December 2016 | Page 19
Major study shows women’s mental health improves with age
N
ew research shows socio-economic advantage and disadvantage are generally the major influences on the wellbeing of women’s mental health in Australia - not the timing of having a baby and other traditional life milestones. Researchers from the Australian Longitudinal Study on Women’s Health (ALSWH) have examined the mental health of 10,438 women as they progressed through normal life transitions, such as parenting, relationships and employment. The latest data found while women who had babies at a younger age tended to have poorer mental health, the mental health of all Australian women tends to steadily improve as they age from their late teens right up until they are aged in their 60s and beyond. Professor Christina Lee, a Professor of Health Psychology at the University of Queensland and chief investigator of the ALSWH, says the results show having a baby at a young age doesn’t “doom women to a life of less positive outcomes”. “We found that women who had babies at different ages tended to come from different socio-economic backgrounds, so women who had babies early, say around an average of 20, tend to be from the country rather than the city, tend to come from families with reasonably low levels of education, and tend to show us some indications of disadvantage. Those factors are often associated with lower mental health. “What we found was that those who had their babies later, they tended to be better educated, urban dwelling, somewhat more advantaged, and they had higher mental health - but when you took into account socio-economic differences, the differences in mental health went away.
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“So what you might conclude from that is, that rather than the age at which you have a baby determining your level of mental health, what it’s saying is that the circumstances you find yourself in, have a lot to do with when’s the right time for you to have a baby - and may also affect your mental health.” Professor Lee says the data shows women generally struggle most with poor mental health in their late teens and early 20s. “We kind of started with the stereotyped idea that young women are carefree and everything is lovely for them but we found that that was not at all the case,” she says. “This is the time for women when concerns and anxieties tend to be at their peak - this is a difficult time. “But women can get through it, some people need some help, but you can get through it. “Women’s mental health does improve quite significantly. We think this is a lot to do with them developing a little more self confidence, developing a sense that things go wrong but you can cope with them, and developing an adult sense of who you are.” When providing care and treatment for women, Professor Lee says it’s important health practitioners consider the context in which women live. “I know that a lot of allied health professionals and nurses do this anyway, but I think psychology in particular tends to think of mental health problems as very much a problem of the individual - you’ve got something wrong with you and you need it fixed. “If you’ve got very severe psychiatric disorders, yes that’s fair enough, but we also need to consider the contexts that women live in, grew up in, and are struggling to make
HT-612 1/2PG FULL COL sense of the world in, and it’s not always the individual who is the seed of the problem.” Professor Lee presented the latest research at the 14th International Congress of Behavioural Medicine in Melbourne recently. The Congress shines the spotlight on research findings in behavioural medicine, a field that combines both medicine and psychology - focusing on how people’s thoughts and behaviour affect their physical and mental health. At the Congress, Professor Lee, who is also the editor-in-chief of the International Journal of Behavioral Medicine, was presented with the Distinguished Scientist Award for her outstanding contributions to scientific research. Under the ALSWH, researchers have been studying the physical and mental health, including the psychosocial aspects of health and access to health services, of more than 58,000 Australian women since 1996, in three cohorts, who were aged 18-23, 45-50 and 70-75. Evidence from the study has been utilised to underpin health policy, including the Quality Use of Medicines, National Tobacco Strategy, Watching Australia’s Weight, Active Australia and the National Continence Strategy. In 2012-2013, researchers recruited a new generation of women - a cohort of 17,000 women aged 18-23. Professor Lee says the project, one of the largest and most complex studies of women’s health in the world, has generated more than 350 peer-reviewed journal articles in the past 21 years, mostly related to chronic disease prevention, mental health, sexual and reproductive health, and healthy ageing. “Being part of this study, as I have been since 1995 is just a huge privilege,” she says. “It’s just a privilege of being able to see the richness and diversity of Australian women’s lives, it’s fantastic.”
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HealthTimes - December 2016 | Page 21
Physiotherapist goes the extra mile for rural patients By Karen Keast Growing up on a dairy farm in a small town of Ngongotaha, near Rotorua, Amy Dibley knew how difficult it was for rural residents to access services, such as physiotherapy, in their nearest town. After graduating from Auckland University of Technology (AUT) and living, working and travelling the globe for four years, Amy returned to New Zealand with the ambition to take physiotherapy services to the doorstep of small, rural communities. Today, Amy is the director of Physio Direct, a rural physiotherapy service with 10 physiotherapists that provides treatment to about 300 patients each week, in areas ranging from Rotorua to Matamata, Putaruru, Murupara, Whakapapa and Ohakune. The venture has been such a success, Amy was recently named the overall winner of Rural Women New Zealand’s annual Enterprising Rural Women Awards. Amy said the award is recognition of the hard work that’s gone into establishing her physiotherapy business over the past five years. “Having a model like mine is challenging and physios are always hard to find, being on the job shortage list here,” she said. “Having an award like this is great for the company, not only for the communities we work in - knowing they are part of a model that is helping bring a service to the rural areas, but also for future physios who want to be part of a team that has this as its vision and has been recognised nationally for it.” When Amy first launched Physio Direct, she created a business model designed to attract physios to work in rural areas and in her clinics.
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“I thought of who my target physios were, what they would want and need to make rural living easier, and how I could be an attractive company to work for,” she said. “I decided to base my business model on the experience I had when I was working in the UK. “When I was working there, I was happy to work anywhere - not having any family or friends there. “I didn’t care where I went, as long as I had a place to stay, good money, and knew I wasn’t going to be staying there for too long, as I was all about experiencing something different and exciting.” Amy said building her business hasn’t been an easy road - it’s taken a lot of hard work, long hours, stress, anxiety and determination. “If you want something you have to be prepared to work hard for it - nothing just happens,” she said. “Everything you do has an effect on something else. If you want to do something different - go for it and good luck!” Eventually, Amy hopes to expand her business to establish clinics in the Pacific Islands, delivering physiotherapy services to those who need it most. “It would be great to be able to help people on a larger scale who have limited health services,” she said. “I’ve done a lot of travelling and have seen first hand how a simple injury can be devastating on people and their families, and so easy to fix.”
For more articles visit HealthTimes.com.au
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HealthTimes - December 2016 | Page 23
The rise of natural medicine and therapies
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hile the origins of natural medicine and therapies can be traced back more than 2500 years ago to ancient China, many Australians are today turning to complementary treatments to boost their health. Natural medicine, also known as complementary or alternative medicine, is a burgeoning industry. At least two out of every three Australians use some form of complementary medicine, while a survey found usage rates as high as 87 per cent among some patient groups, such as women with breast cancer. The sector is also home to an increasing number of practitioners, spanning disciplines ranging from acupuncture and aromatherapy to Ayurvedic medicine, Chinese herbal medicine, chiropractic, osteopathy, myotherapy, naturopathy, shiatsu, homoeopathy, nutrition, musculoskeletal therapy, oriental remedial massage therapy and Western herbal medicine. The peak professional body, the Australian Natural Therapists Association, has a membership of 10,000 accredited practitioners nationally while three professions - chiropractic (which has 5167 practitioners), osteopathy (with 2094 practitioners ) and Chinese medicine (with 4825 practitioners including acupuncturists, herbal dispensers and herbal medicine practitioners) are now regulated under the Australian Health Practitioner Regulation Agency (AHPRA).
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Despite health care consumers embracing alternatives to conventional medicine, little scientific evidence exists to prove the benefits of most natural medicine and therapies. While a range of modern drugs, such as aspirin, are created from herbs, many health practitioners in the conventional medical professions consider natural medicine and therapies a grey area until they can be underpinned by strong scientific, not anecdotal, evidence. An evidence base The Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), at the University of Technology, Sydney (UTS), is working to sort out the fact from the fiction. The critical public health research centre is leading scientific investigation of complementary and integrative medicine use and practice, spanning areas such as rural and urban health, women’s health, ageing, chronic illness, cancer care and traditional/Indigenous medicine. The centre is also examining workforce and professional practice issues right through to primary health care and health policy, regulation and legislative issues. ARCCIM director Jon Adams, a Professor of Public Health and ARC Professorial Future Fellow, says the centre is involved in more than 40 research projects, subjecting complementary health care to critical scientific investigation, in Australia and overseas.
Professor Adams says it’s time we knew more about this booming area of the health sector.
“If you ignore complementary medicine, the realities of its use and practice, and the fact that it already exists and it’s prevalent, you are opening yourself up to actually not doing good service to patients, patient outcomes and efficient health care because you are not informed,” he says. Professor Adams says while most people question whether natural medicine and therapies work, are effective and safe, there are other questions that also need answers. “If people are using complementary therapies and medicines in the community, and they are at very high prevalences, then actually there are public health and health service issues that we need to address straight away,” he says. “They are - how are they using them, do they use them with good evidence, how do they make good decisions about using them or not using them, and do they inform conventional health care providers like doctors and other people in the hospital system about their use of complementaries and other practices? “So instantly, as far as I’m concerned, there’s a whole agenda there that has been, until very recently, pretty much ignored or missed. “What we’re doing is we’re not suggesting that the question of - does it work - is irrelevant, far from it. That is highly relevant, everything needs an evidence base. “The point is, if all we ask is - does it work then we’re not really, truly understanding what are the behaviours, the decision-making, the information seeking, and the practices that are actually currently going on right now.” ARCCIM has completed a large study examining almost 2000 pregnant Australian women and their use of complementary medicine and practices.
It found about 60 per cent of pregnant women will visit a complementary medicine practitioner, such as an acupuncturist, chiropractor, naturopath, reflexologist or massage therapist, while between 80 and 90 per cent of pregnant women access complementary medicine throughout the pregnancy and labour process. “This is one example of information that we didn’t yet have that’s highly scientific and empirical so we can inform other people in the health care system, in this case obstetricians, midwives, the families, the women themselves, about what’s going on in this space because most people only have anecdotal evidence,” Professor Adams says. Integrating natural with conventional medicine While some studies have shown the benefits of complementary treatment, such as acupuncture for treating several types of chronic pain, including back and neck pain, osteoarthritis, chronic headache and shoulder pain, the scientific evidence for many natural medicines and therapies is still evolving. In Australia, most natural medicine and therapies exist outside of the medical health care system. Professor Adams says despite the clear divide, there are some pockets of movement towards integrating natural medicines and therapies with our conventional, Western model. Some acupuncturists are now working in health clinics while some GPs are also providing acupuncture as medical acupuncturists. “There are some GPs who are very openminded about these complementaries - offering them to patients and talking to patients about them and maybe even informally referring people to these therapists and medicines,” Professor Adams says.
For the full article visit HealthTimes.com.au HealthTimes - December 2016 | Page 25
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What is Birthing on Country?
A
cultural tradition that heralds back thousands of years, Birthing on Country is when Australia’s first peoples embrace traditional practices to connect pregnant women, birthing, and newborns with their ancestors’ land, known as Country. There is no singular approach to Birthing on Country. Aboriginal and Torres Strait Islander communities right across Australia vary in their cultural values and the way they approach Birthing on Country. In a joint position statement, the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), the Australian College of Midwives (ACM) and CRANAplus, describe Birthing on Country as ‘“a metaphor for the best start in life for Aboriginal and Torres Strait Islander babies and their families”, which provides an appropriate transition to motherhood and parenting, and an integrated, holistic and culturally appropriate model of care for all’. Rhonda Marriott, Professor of Aboriginal Health and Wellbeing in the School of Psychology and Exercise Science at Murdoch University and a descendant of the Kimberley Nyikina Aboriginal people, says Birthing on Country is traditionally considered a model of birth in a remote community, outside of a hospital, with a traditional midwife in attendance. But Professor Marriott, who has a joint appointment with the Nursing and Midwifery Office at the WA Health Department and is also co-chair of the WA Health Aboriginal Nurses and Midwives Council, says there is no onesize-fits-all approach to models of Birthing on Country. In fact, Birthing on Country can be implemented in any setting - from remote areas to major cities. “It’s not just about the Birthing on Country in a remote setting, because there are many women who are Birthing on Country who live in
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the city, and they are Birthing on their Country,” she says. “It might be that Birthing on Country is a remote community where there’s minimal supports in the traditional sense of medical support. “It might be at-home birthing experiences and it might be birthing in a maternity service, whereby the cultural supports are there.” Closing the Gap Birthing on Country provides not only important cultural elements but also a range of health benefits for Australia’s first peoples. Pregnancy, birth and early childhood are known to be critical periods for the health of mothers and their babies. Maternity services that support Aboriginal and Torres Strait Islander women and their families to have a birth that meets their cultural standards will work to improve health outcomes and Close the Gap. Indigenous babies are almost twice as likely to be born at a low birthweight than non-Indigenous babies. The Closing the Gap - Prime Minister’s Report 2016 shows infant mortality rates for Aboriginal and Torres Strait Islanders stood at 6.4 infant deaths per 1000 live births in 2014, compared with 3.6 per 1000 live births for nonIndigenous people. From birth, Indigenous Australians also have a lower life expectancy that non-Indigenous Australians. Life expectancy for Indigenous males stands at 69.1 years compared to 79.7 for non-Indigenous males. Indigenous women can expect to live to 73.7 years while life expectancy for nonIndigenous women is 83.1. Professor Marriott says more culturally-centred pregnancy and birth experiences will lead to better clinical outcomes.
“The best birth experience without any complications is a right that every woman has and therefore our services need to provide for that,” she says. “They also need the best cultural experience that can be ensured around the time of birth.” Studying Aboriginal births Professor Marriott is leading a fouryear NHMRC Partnerships Project Grant involving 11 local partners, two international partners and a team of 20 researchers to examine the cultural security of Aboriginal women birthing in Perth’s maternity services. Professor Marriott says the project involves speaking with midwives and midwifery educators to investigate the understanding of midwives who support Aboriginal women through birth. Researchers are interviewing Aboriginal women, to identify their needs, and are also speaking with elders about traditional birth supports. “What we are finding is there really needs to be some recommendations around changes to practice and education,” Professor Marriott says. “In that, we are really keen to ensure that there’s better education around midwives for their understanding about Aboriginal people and the differences between Aboriginal people - that there are so many groups across Australia. “Secondly, to increase the number of supports that are available - like Aboriginal maternity group practices by a specialist group, that could be trained to provide support during pregnancy
and continuity of care through the birth experience and into the infant care and parenting.” Woman-centred care Professor Marriott says maternity services should be open to choice and truly womancentred. “If a woman wants her aunty or grandmother or mother to be far more involved in the birth, then we should have moved to a point where that’s welcomed and accepted,” she says. “It can be quite a fearful event if you’re young and you don’t know what’s happening - mum’s not there, aunty is not there, grandma is not there, and they are not allowed to come in - because you are not allowed to have too many people in the room. “We need to try and reduce some of that fear and concern and turn it into positive support. “If you allowed aunties and grandmas and mums into the room, sure there will be extra people in the room, but heavens - if you then have an excited young girl who is delivering her baby, isn’t that better, instead of someone who is terrified?” While some traditions, such as Welcoming a Baby to Country through a smoking ceremony, using leaves and wood from Country, are unable to occur in hospitals, Professor Marriott says the important tradition can still take place - in the first few days following the mother’s discharge from hospital.
For the full article visit HealthTimes.com.au HealthTimes - December 2016 | Page 29
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