The Health Scoop - Issue 20: Rural/Remote Health by The Nursing Post

theHealthScoop The Career and Education Magazine for Health Professionals

Menzies School of Health Research Study examines new ways to promote active living in remote communities

14 October 2013

- ISSUE 20

Rural/Remote Health

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Editor’s note... Hi Readers, We are delighted to welcome you to Issue 20 of The Health Scoop magazine featuring Rural/Remote Health. This issue, we feature Royal Flying Doctor Service and Derby Flight Nurse, Jeanette Spark who loves her role which allows her to combine her passion for nursing with her love of the Kimberley. Ms Spark is originally from Victoria and was offered the position at the RFDS base in Derby in January upon completing her midwifery studies on an RFDS scholarship. She accepted the offer without hesitation and hasn’t looked back. To read more about Jeanette’s story and working with the RFDS, turn to page 12. We also feature Menzies School of Health Research and a study examining new ways to promote active living in remote communities. With an acute need to tackle shocking levels of chronic disease in remote Indigenous communities, researchers at the Menzies School of Health Research have conducted the first ever detailed study documenting Indigenous perspectives on active living. To read more, turn to page 14. Our next issue will arrive on Monday 28 October featuring Working Abroad. Until then, take care.

Naomi Byrne Editor

Rural/Remote Health

Next Issue: Working Abroad

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Contents... Feature

Rural/Remote Health 8

Remote Area Health Corps

A long way from homeâ&#x20AC;Ś. Mary-Anne Menhennitt tells her RAHC story

Rheumatic heart disease in pregnancy

Royal Flying Doctor Service

Menzies School of Health Research

Study examines new ways to promote active living in remote communities

Rural Health West

The Rural Health Professionals Program

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Rural/Remote Health

West Beach Esperance, image courtesy Tourism WA

Rural Health West The Rural Health Professionals Program - Nationally funded strategy The Rural Health Professionals Program is a workforce initiative designed to increase, and improve the distribution of, the allied health and nursing workforce in rural and remote Australia. The Rural Health Professionals Program is the first nationally funded and coordinated strategy to increase allied health and nursing workforce to areas of greatest need.

Mr Dinnison learnt about the program through a presentation made at the University of Western Australia, when they visited to speak about the Rural Health Professionals Program and the associated funding that is available for eligible candidates.

Rural Health West administers the program in Western Australian, and has placed over 60 health professionals in the last 12 months, one being 26-year-old Angus Dinnison, who made the move to Esperance, on the Western Australian south coast.

“It is costly to live here, so the financial incentives made it affordable for me to do.

“When I spoke with them at length I knew it was a perfect opportunity for me,” he said.

“Importantly, it was the chance for me to fast-track my career.

I’ve really enjoyed the learning opportunity - as a remote professional I’m also seeing far more patients generally than I would if I was still in the city – meaning my skills will advance much quicker.” Additionally, working in a surgery with two experienced dentists who often undertake extended activities has provided enviable mentoring opportunities. “I have two great mentors who are helping me a lot – and I’m also seeing them undertake work that in more urban areas would often be referred to a specialist. Patients often prefer to have extended work done here rather than travel to Perth – so we are all having the opportunity to undertake some really diverse and interesting work.” Living in a regional centre provides both challenges and opportunities: “the great thing is that the people are really friendly and the location is amazing - being a coastal town,” Angus said. “It is a challenge being located so far from Perth – so the financial assistance to help with the cost of living and travel helps make sure I’m not disadvantaged financially by being here.” If you are interested in a rural career in Western Australia, please contact Rural Health West or visit the website to discover the variety of positions available throughout the state.

Welcome to The Health Scoop magazine and online website specifically targeted towards Nurses and Allied Health Professionals. Our magazine is distributed fortnightly and free of charge to all major hospitals, clinics and rural and remote healthcare organisations located across Australia.

Advertise with us! For further information and a copy of our Media Kit, please contact: Michael Kuhnert marketing@healthscoop.com.au

Rural/Remote Health

Dental Therapist, Mary-Anne Menhennitt at Milingimbi.

Remote Area Health Corps A long way from home…. Mary-Anne Menhennitt tells her RAHC story While I’ve been a Dental Therapist for 25 years, it was October 2009 when I started a new journey that continues to this day. My journey has taken me to places in Australia I would otherwise never have been able to visit and given me experiences I would never have imagined… My introduction to Indigenous and remote health was in Gapuwiyak, 250kms west of Nhulunbuy in East Arnhem. Since then, I’ve also worked in Milingimbi, an island community also in East Arnhem as well as the community of Kalkarindji, 500kms south west of Katherine. In May this year, I spent two weeks working in the Department of Health dental truck in Tennant Creek. Four communities, all quite unique and seemingly a world away from my 8

regular life in a town on the NSW/Victorian border – Tocumwal – three hours north of Melbourne. I heard about the Close the Gap program and the Remote Area Health Corps (RAHC) not long after the initiative began. I’m fairly adaptable and resourceful so I applied without really knowing much about what the job would entail. I thought ‘how different can this dental work be?’. Well, I soon found out when I went on my first placement and discovered what ‘remote’ really means. To get there it took a three-hour drive to Melbourne, four-hour flight to Darwin, a day in Darwin for the Cultural Orientation Training and briefing, a ninety minute commercial flight

Transport to and from Gapuwiyak.

to Nhulunbuy/Gove, then a 30 minute flight in a six-seat Cessna to Gapuwiyak. My placements have educated me about the need for oral health and general health services in the more remote parts of our country. I found the scale of the work to be challenging sometimes but this was offset by the knowledge that whatever help I could give was needed and appreciated by the communities. My eyes have been opened to a whole new world of Aboriginal culture. The more I have learned, the more I realise how much more there is still to know and understand. At first, I found it disconcerting that English was not the first language spoken by most people around me in the community. In fact, most Aboriginal people there, even the children I talked to, could speak three, four or even more languages. I felt most inadequate but the kids were happy to teach me a few key words although they did have a giggle at my pronunciation attempts.

Probably the best aspect of remote work has been the people. I have met so many friendly, interesting people ranging from the community members and patients to the other Dental Assistants and RAHC, Department of Health and local clinic teams I work with. These lovely people make all the difference when I am a long way from my home and family. Working in a remote community can be many things â&#x20AC;&#x201C; challenging, exhilarating, exhausting, exciting and fulfilling. Iâ&#x20AC;&#x2122;ve gained so much through my placements and Iâ&#x20AC;&#x2122;m gratified that my skills and professional experience can contribute to making a difference. There is still a great need for dental and general health professionals to improve health outcomes for Indigenous Australians and I am looking forward to continuing my work in remote Indigenous communities.

Rural/Remote Health Rheumatic heart disease in pregnancy have RHD, with rates up to 54 times that of the overall Australian population. “If you’re Aboriginal or Torres Strait Islander, the impact is likely to be greater, with higher rates of complications, particularly for those women who need valve repairs or mechanical valves,” says Geri Vaughan, national project coordinator for a new study on RHD in pregnancy, which is based at the University of New South Wales. “The impact during pregnancy can be significant: an increased cardiac workload can exacerbate existing RHD and cause complications in women who have not been previously diagnosed. Yet this disease is largely preventable.” The research will be breaking new ground, according to Geri. “Most of the information and guidelines we have on rheumatic heart disease are based on studies of nonpregnant adults,” she says.

Geri Vaughan, national project coordinator for a new study on RHD in pregnancy.

Rural and remote collaborations are driving the largest study into the impact of rheumatic heart disease (RHD) in pregnancy ever conducted.

“What we do know is the importance of women being diagnosed early, with regular monitoring during pregnancy and multidisciplinary care.” A large team of investigators, including Jonathan Carapetis, Director of the Telethon Institute of Child Health Research in Perth, and Sue Kruske, Professor of Maternity Services at the University of Queensland, is researching the impact of this disease in pregnancy.

Of the nearly 300 maternity units across Australia and New Zealand participating in the nation’s most extensive study into rheumatic heart disease in pregnancy, 42% of Australian sites are located in outer regional or remote areas.

Headed by Professor Elizabeth Sullivan of UNSW Medicine, this four year NHMRC-funded project is using both qualitative and quantitative methods. Participating sites across ANZ report each month and complete web-based surveys on history, clinical pathways and outcomes for pregnant women with RHD during Jan 2013-Dec 2014.

Aboriginal and Torres Strait Islanders in remote regions of Australia have among the world’s highest documented rates of RHD in the world. Despite rheumatic heart disease being a rare condition overall, 2-3% of pregnant Aboriginal and Torres Strait Islander women in the NT

Critical to the study is the extensive reporting system that has been developed. The quantitative part of the study is utilising the framework of the Australasian Maternity Outcomes Surveillance System (AMOSS), a bi-national surveillance and research system that monitors serious

“

A big part of what we’re doing is raising awareness about rheumatic heart disease. We are working closely with RHD Australia and other key stakeholders to raise the profile of this disease.

all those working with women at higher risk of RHD in pregnancy, including remote health, Aboriginal medical services, antenatal care and cardiac care. The second arm of the study is a qualitative study which is exploring women’s experiences with rheumatic heart disease as they intersect with health and maternity services during pregnancy.

Kylie Tune, midwife and NT project coordinator who is based at Menzies School of Health Research.

conditions in pregnancy, based at University of New South Wales. More than 300 hospitals across Australia and New Zealand are involved in AMOSS. “One of the strengths of this study is we use this AMOSS system which is providing an infrastructure for surveillance and data collection,” says Kylie Tune, midwife and NT project coordinator who is based at Menzies School of Health Research.

“A big part of what we’re doing is raising awareness about rheumatic heart disease. We are working closely with RHD Australia and other key stakeholders to raise the profile of this disease,” commented Kylie. This study forms the largest population-based research of pregnant women with RHD ever studied. It will enable benchmarking to identify key attributes of successful, culturally safe models of health care for women with RHD in pregnancy, based on working with those who experience RHD and its impact. Findings will benefit over 1500 disproportionately Indigenous women with RHD likely to give birth in ANZ over the next ten years.

To find out more about this study, contact amoss@unsw.edu.au

“It’s so important to not miss any women who may be eligible for the study. Each region in ANZ has slightly different health models, health systems – and we want to look at what is and what isn’t working across the jurisdictions. High turn-over of staff and complicated health information systems are just some of the challenges of surveillance,” says Kylie. Enhanced surveillance processes are being developed in regions of high risk populations to extend the network to 11

Rural/Remote Health

Royal Flying Doctor Service Derby Flight Nurse, Jeanette Spark.

Royal Flying Doctor Service Combining passion for nursing with love of the Kimberley

There are no typical days for Ms Spark, she never knows what to expect when coming to work in the morning and that’s just the way she likes it.

“

I love the variety of my job; it’s all about adapting to constant changes in the environment and the patients you are working with.

“

Basing herself in Derby as a Flight Nurse for the Royal Flying Doctor Service (RFDS) allows Jeanette Spark to combine her passion for nursing with her love of the Kimberley.

“At the RFDS you never know exactly where you’ll be or what you’ll be doing from day to day,” she said.

hospital to working on a road side or at a remote station on any given day.”

“I love the variety of my job; it’s all about adapting to constant changes in the environment and the patients you are working with. I can do anything from working in a

Ms Spark is originally from Victoria and was offered the position at the RFDS base in Derby in January upon completing her midwifery studies on an RFDS scholarship.

“The Kimberley is the most diverse environment there is, it’s a truly amazing place full of amazing people and I love the sense of community spirit.” “While working in Fitzroy Crossing I experienced firsthand the importance of the RFDS’ role in remote towns.” Ms Spark said working for the RFDS was also a great move for her career. “The RFDS is the cream of the crop for nursing, the reputation of the organisation really precedes itself,” she said. “The RFDS has very high standards when it comes to patient care, we might be working remotely but that doesn’t compromise the degree of expertise and professionalism I’ve found the organisation maintains. “For me, working with the RFDS helps keep my skills sharp. It gives me a lot of variety, I can go from providing health care to a trauma patient or a neonate without batting an eyelid. “People who live in remote areas of Australia rely on the RFDS to access vital health care. The RFDS’ motto - the furthest corner, the finest care – is what it’s all about. “I would highly recommend a role with the RFDS to any nurse thinking about it – you get a chance to see Australia and meet the amazing people that make up our country. Plus you make a difference to people’s lives in only the way a nurse can.

“

I would highly recommend a role with the RFDS to any nurse thinking about it – you get a chance to see Australia and meet the amazing people that make up our country. Plus you make a difference to people’s lives in only the way a nurse can.

“

She said accepting the role was an easy decision to make, having fallen in love with the Kimberly while previously working at Fitzroy Crossing Hospital.

“I work with a fantastic group of people; I’m so inspired by the doctors, nurses and pilots that I have met in this role. “Getting to know people in remote communities is one of the best parts of my job. “We visit a lot of remote Aboriginal communities like Balgo, where half the town shows up when we visit. “The RFDS has always been an iconic organisation and we are almost celebrities in these towns, it’s a great feeling to receive such a great reception on the road. “I love being able to put a smile on people’s faces like that, some of the communities are so remote we are the only contact they have with the outside world for an extended period of time. “Now I see myself staying here long term, I’ll stay as long as they will have me!”

For further information about the Royal Flying Doctor Service, visit www.flyingdoctor.org.au

“Working for the RFDS is perfect for any nurses who want to challenge themselves and extend themselves professionally.” Ms Spark said another highlight of her job was the buzz she gets from being on the scene at a primary retrieval. “It’s an awesome experience, working as a team with the elements of aviation, medicine and nursing combining in a way that doesn’t anywhere else,” she added. 13

Rural/Remote Health

Former AFL player Dean Rioli still keeps active with young Indigenous Northern Territorians.

Menzies School of Health Research Study examines new ways to promote active living in remote communities

Lead author, Sharon Thompson said the marked health disparities between Indigenous and non-Indigenous populations and the need to involve Indigenous people in finding solutions were driving factors behind her research. “The burden of chronic disease in remote Indigenous Australia is more than double that of non-Indigenous populations and increasing participation in physical 14

“

The burden of chronic disease in remote Indigenous Australia is more than double that of nonIndigenous populations and increasing participation in physical activity could improve the situation.

“

With an acute need to tackle shocking levels of chronic disease in remote Indigenous communities, researchers at the Menzies School of Health Research have conducted the first ever detailed study documenting Indigenous perspectives on active living.

activity could improve the situation,” Thompson said. The study featured interviews with members of two remote Northern Territory communities: one in the tropical Top End and the other in the arid Central Desert region.

“

This suggests that health professionals must listen to and involve Indigenous Australians when developing culturally appropriate remote health promotion strategies.

overseen by the North Australian Indigenous Land and Sea Management Alliance (NAILSMA); as well as youth diversion and outdoor education programs that enable time to be spent walking on country with significant elders,” Thompson said.

Thompson said their research showed that the meaning of physical activity is different in remote Indigenous cultures so Western-style physical activity health promotion is unlikely to be effective for everyone.

“However, greater cohesion between government departments and the many stakeholders in combination with more research is needed to show how these kinds of environmental and youth diversion programs can provide effective models of Indigenous physical activity health promotion.”

“This suggests that health professionals must listen to and involve Indigenous Australians when developing culturally appropriate remote health promotion strategies.

This research, authored by Sharon Thompson, Julie Brimblecombe and Richard Chenhall, is published in the open access journal, BMC Public Health.

“When participants talked about being physically active they talked about working and walking on the land with significant others - usually family. They described work and cultural activities - like hunting and teaching others about the land - and they want to do more of these kinds of physical activities,” Thompson said.

The full article can be accessed at: www.biomedcentral.com/content/pdf/1471-245813-473.pdf For more information about Indigenous health research please visit Menzies School of Health Research’s new website at www.menzies.edu.au

From interviews it was clear that adults did not engage in physical activity just to improve their health. While it was acceptable for children to swim in pools, run and ride bikes, the thought of adults partaking in these kinds of activities was not. Thompson said physical activity in remote communities is strongly associated with being productive and meaningfully engaged with the environment and culture. “As a ranger who participated in the project explained - his work allowed him to meet his traditional physical activity and dietary needs, and the needs of the environment in a culturally appropriate way.” This research supports the importance of ‘caring for country’, a term which encompasses the management of natural and cultural resources and associated activities, as a broad inter-sectoral health strategy.

A new study shows health professionals must engage Indigenous Australians when developing culturally appropriate remote health promotion strategies.

“People in remote communities want to live healthier lives and there are several excellent environmental initiatives helping them to achieve this, such as the Working on Country Indigenous ranger programs, those 15

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POSITION VACANT Miwatj Health is an Aboriginal Community Controlled Primary Health Care service with clinics in the East Arnhem region of the Northern Territory. This is an exciting senior management position developed to complement much needed services aimed at improving the health of local people in Aboriginal communities within the East Arnhem Region.

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