President’s Report

Associate Professor Carol McKinstry | OTA President

The theme of this issue ‘Regional, Rural and Remote’ has special relevance to me. I have spent most of my life in regional Victoria. I grew up on my family’s farm on the Campaspe River at Barnadown, attended the small local primary school at Goornong with three other pupils in my grade, and then attended secondary school and later worked in Bendigo after I graduated.

As a clinician, I worked with people living in Bendigo and up to 150km away—helping establish regional rehabilitation services so people did not have to travel to Melbourne. Later, as an academic, I established an occupational therapy course in Bendigo to provide tertiary educational opportunities for regional and rural students and workers.

I am passionate about improving the health inequities of those living in regional, rural and remote areas—having seen firsthand the impact that a lack of access to services can have. It is well-documented that there are higher incidences of chronic disease, cardiovascular conditions, cancer, mental illness, and suicide in rural areas. While country living has many advantages, it also has health concerns. The number of health professionals, including occupational therapists, per 100,000 people is much less the further you move away from metropolitan cities.

While the lack of medicos in the bush attracts a lot of attention, the need for allied health professionals can often be overshadowed.

A Rural Health Commissioner report released earlier this year highlighted issues associated with a maldistribution of the Australian allied health workforce. University Departments of Rural Health (UDRHs)—initially established to attract more metropolitan medical students to rural placements and communities—much later included allied health and nursing students. However, many still focus on converting metropolitan students to rural practice, when all the research shows that students from a rural upbringing are a much better bet.

I am passionate about improving the health inequities of those living in regional, rural and remote areas— having seen firsthand the impact that a lack of access to services can have.

One challenge in building a rural occupational therapy workforce is attracting enough students with the academic requirements to undertake our courses. Aspiration is a huge issue in rural schools. I frequently tell the story of a debutante ball in a rural community in which I am on the local health service board. As board chair, I was invited to be in the official party to which each of the nineteen pairs of debutantes were presented—along with a small description of their interests and life goals. No boys, and only a handful of girls, had any aspirations to attend university. This community is only 60km from Bendigo and 200km from Melbourne.

Lifting aspiration for country students was also highlighted in the Napthine Report’s National Regional, Rural and Remote Education Strategy (2019). Tertiary participation rates of regional, rural and remote students are way too low for a country like Australia.

While doing my occupational therapy course in Melbourne, people were amazed that I had been admitted—firstly because I was from the country, and secondly because I had attended a public high school. Admittedly, that was some time ago. Now as an educator, I love teaching rural students, and they make great occupational therapists. They are very resilient and take things in their stride. Undertaking placements in regional and rural areas gives them a solid base for future practice,

as they gain broad experience working with a whole range of people with different needs. They also realise they can make a substantial difference to rural communities.

Retaining rural occupational therapists can be a challenge with inadequate support. Accessing supervision and continuing professional development can be difficult for both recent graduates and experienced occupational therapists. Lack of career pathways is another frequently reported issue.

Managing the dual relationship of living and working in a rural community can also be a challenge. My husband, originally from Melbourne, does the supermarket shopping early Saturday morning to avoid bumping into one of his patients. For those raised in rural areas, this is not so much an issue. I have played in sporting teams with people who later become my students, and frequently buy coffee from my students working in a local café.

Yet more importantly, networks and community connections are much easier to establish in rural and regional settings.

Reflecting on a very challenging year, there has nonetheless been positive outcomes for rural people. The massive uptake of telehealth has seen clinicians, including occupational therapists, increase access to health services while also reducing the need for travel. Rural occupational therapists have also benefited from better access to continuing professional development.

I have played in sporting teams with people who later become my students, and frequently buy coffee from my students working in a local café.

Earlier in the year, the OTA divisional annual meetings were held via teleconference—and it was amazing to hear from occupational therapists who had been unable to attend in the past. Hopefully we will retain some of the positive changes that will increase participation opportunities for regional, rural and remote occupational therapists within OTA.

I would also like to acknowledge the difficulties that everyone has faced due to COVID-19.

Challenges associated with a worldwide pandemic include upskilling in technology to deliver services, wearing PPE, adopting extra infection control practices, working from home, and juggling other responsibilities such as distance education and impacts on private practice revenue.

Students have had a tough time, too, particularly those in their final year, with the uncertainty of being able to finish their courses. This has been very evident in Victoria. Academics from the following universities that source placements in Victoria would like to thank clinicians and service managers for their flexibility, generosity, and willingness to provide placement opportunities during these trying times: Australian Catholic University, Charles Sturt University, Deakin University, Federation University, La Trobe University, Monash University, and Swinburne University. Preference has been given to final-year students, and the vast majority will be able to graduate.

Thank you to everyone throughout Australia who has provided placements and learning opportunities for students, and supported them in a different way of learning.

Finally, I would like to acknowledge OTA staff, the Board and other volunteers such as special interest group convenors for their work during these different times. Hopefully we look forward to a bigger, better and brighter 2021 when we can network online as well as face to face.