Rural Road To Health podcast

Rural Road to Health

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Profs Sarah & Roger Strasser - Adventures in Rural Health Education & Research 1:22:40

vor 8 weeks1:22:40

1:22:40

Prof Sarah Strasser and Prof Roger Strasser, a trailblazing couple in the world of rural health, rural health research and rural medical education. Episode summary: 01.15 Sarah and Roger share how they became interested in rural health and some key highlights from their careers 15.30 What did they find most rewarding about living and working in rural areas and what was challenging? 20.50 How did they balance all their different roles with their family life? 29.30 What have been the most important research projects that they have worked on? 51.30 What is NOSM and what makes it different from other medical schools? 59.45 What were the enablers for the development of NOSM? 1:05.00 What has it been like to be a woman and trailblazer in the rural health space over time? 1:11.15 What do they see as being the research focus in rural health in the next 5 to 10 years? Key Messages: They have lived and worked in different countries and in different rural and remote communities. They both share a passion for rural communities and rural health. In 1991 the first National Rural Health Conference inspired a lot of activity around rural health in Australia. Monash University developed rural training pathways and the Monash School of Rural Health. Roger became the first Professor of Rural Health in Australia. Roger acted as the Founding Dean of the Northern Ontario School of Medicine in Canada for 17 years. This is a multi-site rural based full medical school. Sarah started her academic journey in Canada by teaching nurses about whole person medicine. She then became regional director of general practice training in Australia and then became the national director of rural health and covered Indigenous health. Sarah later became dean of Health Sciences at the University of Otago New Zealand. Most enjoyed: The sense of space and being part of the community. Having a very privileged role which lets you get to know the deep issues within the community. Using that privilege in an appropriate way and making a difference for the better. Relationships with the people and the community. Community connectedness. Challenges: Lack of child care that works for you. Lack of resources. Realizing how frustrating it is when things that you need on a daily basis run out or are not working, this can be a quick way to get burnout. Balancing their careers, different professional roles, and raising a family was challenging. Work-life balance gives the impression that work is not part of life. Roger prefers the concepts of work-style life-style mix. Research and teaching are integral to clinical practice. In the daily interaction with patients there are often questions that come up, occasionally there is not an answer in the literature or when asking a colleague. This can be part of a new research question to pursue. It is all woven together. It has been wonderful to see how things have changed over time. On one hand some things seem to stay the same, on the other side everything has changed. Over the last couple of years has been going to conferences that are full of people she does not know. Two threads of research. One was a series of studies asking people in rural and remote communities about their needs. They have a security need, they need to feel that there is a safety net. They first need a doctor and a hospital. Then looking at the sustainability of rural and remote services - 22 in depth case studies. Found that the ones that were doing well had active community participation in the running of the health service. Looked at issues of recruitment and retention of healthcare professionals. Explored contributing to factors of success and developed a rural workforce stability framework with 5 country partners. Active community participation again came up as a strong factor for success. The second thead was education and training for rural practice. Recognizing that there is a better chance of medical graduates going into rural practice with early exposure to rural contexts. Rural upbringing, positive rural clinical experiences and postgraduate training that prepares clinicians for rural practice are the three factors that have been shown to be most important. Immersive community engaged education. Seeking out the disconnects and trying to prove alternative ways of doing things. Don’t accept things as they are, go and investigate and find out what needs to be done. Communication and dissemination is an important part of research, share what you find with the relevant people. Encourage community engagement and recognize the importance of patients as teachers. Rural practitioners are naturally effective teachers. Doctors more generally after time in practice through their interaction with patients develop a lot of skill in teaching. Importance of having contracts - doctors and the community knew how long they would be there and gave them an opportunity to renegotiate their position. WHO has published updated policy guidelines in 2021 for the recruitment and retention of the rural health workforce. Their research has been adapted for this document. NOSM came into existence because the community recognized that they needed their own medical school to have a sustainable health workforce. It is the first medical school in Canada with a social accountability mandate. This is about improving the health of the people and communities of Northern Ontario. NOSM has a full immersive learning experience based in local communities. All students have a year long integrated longitudinal clerkship, living and learning in one community. 77% of NOSM graduates are in general practice, 14% are in other general specialties like pediatrics or general surgery - a very different outcome to other medical schools in Canada. Politics is a large part of establishing a medical school. NOSM has support from the Mayors of the 5 main municipalities, government support and community support. Everything aligned to enable it to happen. Say “Yes And” to opportunities, then add some of your own suggestions or boundaries. If you find that it does not work, let it go. Be aware of the existing rural health research and undertake research which builds and contributes to that. Future research can enable connection of rural communities across countries. It should be undertaken in rural communities, by rural communities and for rural communities. Use frameworks that have already been established so that the research can add value to and build on what has already been done. The Partnership Pentagram or Partnership Pentagram Plus is an example of a possible framework which could be used in this way. Thank you for listening to the Rural Road to Health ! Rural Health Compass…

Rural Road to Health

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Prof Bill Ventres - Healthcare on the Margins & Storylines of Family Medicine 54:48

vor 9 weeks54:48

54:48

Prof Bill Ventres is a family physician, medical anthropologist and (recentrly retired) Distinguished Chair of Rural Family Medicine at the University of Arkansas in the USA. Episode Summary: 1.30 Bill tells us about his professional background and how he became interested in rural health 04.30 What made him choose to live in El Salvador? 09.30 What has he most enjoyed about living and working in rural areas? What did he find most challenging? 13.45 What is Arkansas like, what is the context there like? 19.00 Storylines of Family Medicine - why did he decide to do this project? 29.45 What are some insights about practicing in rural and remote contexts? 33.05 What insights has he had in his work on rural workforce development? 36.20 What were the main challenges for building a rural workforce? 38.55 What are some possible solutions to rural workforce challenges? 43.30 How are rural and urban practice similar and different? 49.15 What would his top advice be to policy makers? 51.10 Top three tips for students and early career professionals thinking about a rural career Key Messages: He has spent his career working with people who find themselves on the margins of society. He started his work in urban underserved settings. After spending some time in El Salvador he returned to Arkansas and started working in rural areas. He is now a student of Latin American Philosophy while living in El Salvador. Many people in rural and underserved areas feel left out, many people in rural and underserved areas feel on the margins of a greater society, and that the medical system does not really attend to their needs. He most enjoyed listening to the stories his patients told and hearing about the experiences that people had. That is one of the wonderful things about being in a small practice, one really gets to know the pulse of all the people in the community. The biggest challenge were the not so happy stories about access. No one wants to be number one in maternal mortality, it is a problem of rural poverty and exacerbated by a long history of exclusion and structural racism. Arkansas is economically the third poorest state in the USA. There is one larger city, Little Rock, famous for what happened in 1957 when the president sent troops so that 9 teenage black children could attend the local white public school and that was the beginning of desegregation. The rest of the state is rural. Walmart is based in northwest Arkansas, so that part of the state has seen a revival. There is huge income inequality. Storylines of Family Medicine - this is a published series of papers that shares reflections on family medicine from residents and family physicians. For caring for a community of patients the medical model does not work well for the kind of things that we encounter in family medicine. There is a transcendental nature to the work that we do in family medicine. The biggest cultural barrier is between medicine and real people. He was interested in hearing what motivated other people (family doctors), they told their stories of what was the one tenant of practice that motivated them. He asked 136 doctors to share their story in the form of short essays. Family medicine means attending to the needs of the patient whatever they may be in the context at hand. Modern rural medicine uses up to date knowledge transmitted to rural communities, rather than the traditional model which sends rural patients to urban centres. The presence of a physician and the presence of a hospital helps to support small rural communities. The future is in the hands of young family physicians. Find other practitioners who are like you and work together to speak up, advocate and receive support. We all need support, and in rural areas sometimes that is hard to come by. We need to find people who hold similar values and share a similar vision of the importance of the work we do. Challenges are financial, attitudinal, geographical, and unanticipated consequences of AI in medicine. Embed yourself in a community, find a community and do that work. Be open to a different way of seeing that work than what you learned in your medical training. We should be training people to be socially accountable to their community. Understanding the needs of rural communities form the biomedical point of view and the social community point of view. It is important to find people and institutions that are helpful. Finding someone whose ideas can resonate with yours. Some international organizations such as WONCA or TUFT and Deep End Project. Linking with organizations and groups like that to become a collective course. Burnout is about not having true meaning behind the work that you do. Have students in your office so that you can pass things on. People living in the interstitium of society are similar in rural and urban areas. Rural health is being disappeared in the US and funding is being cut off at present - stay the course. If you don’t feel comfortable advocating, find someone who is. Medical education is stuck in a model that isn’t working for rural health, let people know, show the work of rural medicine to new generations of physicians. There is a richness to the work and it can be incredible Be in it for the long haul. I am I and my circumstances. Grow that self over time. The work I do is worthy and my circumstances, the rural circumstances that I chose helps to engage me, and I reciprocally engage the community. Bring that to patients. Thank you for listening to the Rural Road to Health ! Rural Health Compass…

Rural Road to Health

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Heather Sherriffs & Dan Martin - ScotGEM & Rural Training on the Orkney Islands 45:13

vor 11 weeks45:13

45:13

Heather Sherriffs & Dan Martin are medical students on the ScotGEM training pathway. They share their experience of graduate entry medical training in Scotland, their placement on the Orkney Islands and how this is shaping their thoughts about their future careers. Episode summary: 01.15 Heather and Dan tell us a bit about their professional backgrounds and how they got interested in rural health 03.30 What have they found most rewarding about working in a rural setting? What has been most challenging? 06.45 What is ScotGEM? 09.30 What opportunities does ScotGEM give students? 12.30 How are hospital placements organized? 14.10 How is the course preparing them for working in a rural or remote setting? 16.30 What is Orkney like, the population, geography and care needs? 20.45 What has there experience been with weather and distance? 24.45 Who is part of the wider healthcare team on Orkney? 27.25 What does a standard GP day and week look like on Orkney? 30.30 What has surprised them about Orkney and primary care? 33.50 What are the two or three key learning point that they have gained from their placement in Orkney? 35.32 How has the experience changed their plans for their future career? 40.30 What is their advice to other postgrads who might be considering going into rural medicine? Key messages: Both Heather and Dan had completed different degrees before going into medicine, law and teaching. ScotGEM is a course to prepare students to become a general practitioner in rural and remote environments. It is a graduate entry degree. It is different to traditional courses as your lectures and placements are integrated, you see patients from day one and you have case based learning. The applied nature of the course really supports learning. They also have a longitudinal integrated clerkship in general practice which lasts 10 months. They have had a lot more one to one time with tutors and doctors at the hospital and in general practice, there is more exposure to clinical skills early on. There is more space to explore and try different things during your course. While on Orkney they spend one day a week at the local hospital during their GP longitudinal placement. Heather would be nervous to work in a rural or remote setting if she had never had a placement in that setting before. It is hard to imagine what the job entails if you have not seen it before. This course prepares you really well to work in a rural or remote setting. Dan says it is a certain skill set to be able to go out and stay in a rural or remote settings. Orkney is a set of islands off the northern coast of Scotland. There is a population of about 20000 people. There is an aging population with people needing quite a lot of social care. During COVID people returned to Orkney. The A&E on Orkney is GP lead and when the weather disrupts travel it can be challenging to manage more difficult emergencies. There are four permanent GP surgeries on Orkney and a small hospital in Kirkwall. The hospital has medicine, surgery, emergency and maternity. GPs to normal general practice but also have their specialist interests such as dermatology, mental health, palliative care or women's health. One of the GP surgeries specialize in diving medicine and have a hyperbaric chamber. There is a higher level of responsibility as a junior doctor, you might be the only doctor overnight running the medical and surgical department. The doctors say that they feel well supported. Just take every opportunity that you can get. If you are interested in something, turn up and ask questions. There is a lot that you can do to develop your clinical skills. It has helped them build their resilience. Dan is now considering a career in general practice and public health in a rural and remote context, he has become more interested in this following his placement in Orkney. Heather has always been interested in working somewhere remote or rural but the past year has solidified that interest and given her confidence to take a job in a rural or remote context. Applying to medicine later in life and having some life experience can be a bit of a super power going into medical training. Interpersonal skills and empathy are building blocks that you can use. Contact Heather: hs249@scotgem.ac.uk Contact Dan: dm332@scotgem.ac.uk Thank you for listening to the Rural Road to Health ! Rural Health Compass…

Rural Road to Health

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Dr Iva Petricusic - Rural Health in Croatia 47:30

vor 12 weeks47:30

47:30

Dr Iva Petricusic is a rural family doctor form Croatia. She is the vice chair of the young doctor committee of the Croatian Medical Chamber and a coordinating member of EUROPREV. Episode summary: 01.15 Iva tells us about her professional background and how she became interested in rural health 03.15 What does she most enjoy about living and working in a rural area? What is most challenging? 07.45 What are the characteristics of the place and community where she works? 13.00 How is primary care organized in Croatia? 17.15 How is family medicine training organized in Croatia? 20.45 What are some of the challenges facing rural communities in Croatia? 26.10 What has changed to improve recruitment and retention into family medicine? 33.00 What would be needed to improve recruitment and retention in Croatia and on the islands? 38.45 What are the challenges faced by doctors thinking about going into rural careers in the European context? Key messages: She would recommend that everyone try living in a rural area to understand the context. Rural areas have a slower pace of living and as a doctor you have multiple roles in the community. As a doctor in the village you are involved with many parts of the patient's life. This can be challenging as you can feel like you are more responsible for them and their health. She often finds herself in situations for which she was not prepared for during her medical training or residency. There are three general practitioners and two pharmacies serving a population of about 5000 people. They also provide care to several nursing homes. Outside of her village there are many places that have been without a doctor for years, they have not had proper medical care, sometimes doctors would be there for a few hours every day or every other day. Young doctors are often placed in such communities and this is very demanding. Local community supported her in getting the supplies that she needed to work but was not available when she arrived. It is difficult to find healthcare workers and attract them to the local region. Not many young doctors decide to stay. Many GPs are retiring. There are 2173 doctors in family medicine in Croatia and the average age is 52 years, of which 858 of those are above the age of 60. It is difficult to find replacements. Slavonia was affected by the war. There are areas that have been abandoned and have difficulty maintaining even a nurse in their community. Croatia has primary care divided into three levels: family medicine, primary pediatrics and primary gynaecology, and it includes dentistry. Primary care is also divided into private and public sectors. However private is not really private, it means that the national insurance company directly has agreements with the doctors working there. In the public sector the national insurance provider has an agreement with the employer that doctors work with. Everyone works for the public sector, but they are paid differently and from the same source. After finishing medical school and internship in Croatia you can work as a GP, in the emergency department or as a prehospital doctor (with the ambulance service). It is suggested but not obligatory to have specialist training in family medicine. Around 1000 of the current family doctors have completed specialty training. The residency program lasts four years, 22 months are spent with a mentor in family medicine practice and 18 months in hospital rotations. There are no rural training pathways in family medicine residency. In undergraduate training there is a requirement to spend 1 week in rural practice. An aging population with multiple comorbidities and complex health needs is becoming more of a challenge. Poor transport infrastructure makes it very difficult for patients to attend secondary care appointments or attend diagnostic tests. Not all villages have an accessible pharmacy, sometimes this means having to organize the medication for a patient to be collected by a nurse, friend or family member who can travel 20km to the pharmacy. Certain tertiary care is only available in Zagreb, 300 km away. This can prolong the time between when a need is identified and a patient receives care. District nurses are important members of the team who can support patient care and share important information about what is happening with patients in the community. Most of the current residency programs in family medicine are funded by the European Union. At present there are about 300 residents in training in Croatia. This is still not enough to compensate for the colleagues that are expected to retire. More local municipalities are recruiting young doctors, such as Istra, they invested funds in this. Local municipalities are looking at how to attract doctors, they offer places in kindergarten for children (childcare is difficult in urban areas), free accommodation, and other privileges. Tourist areas are not attractive to doctors in Croatia due to the extra pressures during tourist season. The number of patients per doctor can grow to 5000 or 6000. Supporting specialist interests for GPs is seen as an attractive opportunity that could support rural practice in Croatia. Housing is a challenge in rural and island communities. Healthcare facilities need investment in equipment and facilities. Croatia has created a Doctor Atlas which provides up to date information on the health workforce. The data is updated daily. Family medicine is something that you either like or don’t like, it is different to other medical specialties. Thank you for listening to the Rural Road to Health ! Rural Health Compass…

Rural Road to Health

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Prof Bruce Chater - A Story of Rural Generalism 1:07:55

vor 14 weeks1:07:55

1:07:55

Prof. Bruce Chater is a rural generalist, Head of the Mayne Academy of Rural and Remote Medicine Clinical Unit in Queensland, Australia, and the Chair of Rural WONCA. Episode summary: 01.15 Prof Chater tell us about his professional background and how he became interested in rural health 05.50 What has he most enjoyed about living and working in rural area and what has been challenging? 11.20 Prof Chater tells us how he has contributed to the development of rural practice and rural medical education in Queensland 16.40 What is it like to be in rural practice for 40 years and how do you step down and hand over well? 24.45 How has he maintained the enthusiasm to keep advocating, improving his practice, and teaching students? 31.00 How has he been involved in advocating for better healthcare for rural communities? 40.25 How was Rural WONCA established? 47.15 What have the key achievements been for Rural WONCA over the past 30 years? 51.05 Why should rural clinicians become part of Rural WONCA? 58.30 What are your top 3 tips for people thinking about a rural health career? 1:01.45 Looking to the future Key messages: Rural practice is a chance to have broad skills. I tell my students - Do you want to know more and more about less and less or do you want to spread your wings and be a generalist? When training the key part is that you go to a good place and that doctors are matched well to rural places. The best part about living rurally is the community. What you see is what you get in small communities. The community is genuine and you get to know the people. Continuity of care, comprehensive care and the capability that you can bring to that. You can do a lot in rural areas. Challenges: lack of local education opportunities for children, getting things across to urban bureaucrats - “geographical narcissism”, clinical challenges and “clinical courage”. Clinical courage - it is about having to step up and do the right thing for someone in your community and it might be about using a skill you have not used in a while. The key element of clinical courage is having a good network of other rural doctors to support you in those situations. Knowing that if you do not do something this person might die. Doctors were isolated and were not a force for good, they had to organize and get together. He was the founding convenor for rural doctors in Queensland and Australia. This led to the formation of the National Rural Health Alliance in Australia. Through the College of Rural and Remote Medicine worked on developing a curriculum for rural medicine. Set up a Statewide clinical network within the Health Department. Developed a model for funding rural hospitals that could be implemented in Australia. Currently also a Professor of Rural and Remote Medicine ensuring there are students in rural areas and making sure there is research about rural areas. Has recently retired and handed over his practice and local hospital to a new doctor - this was a test of the theory and practice he has been advocating for. It is important to have an exemplar practice, rural practice should not be somewhere where you are making a massive income, but you should be well remunerated. You should help people that need help. In Australia there is a mix of public and private practice, he has done a mixture of both and found that this has worked well. Those that can afford to pay for the service and those who can not pay have a good safety net. Be a solution not a problem to the health system. The key has been to get lots of students and young doctors into the practice. Do all the students come back, no, but it is about getting some of them to be inspired to consider rural practice. You can not be what you can not see. The doctor that has taken over his practice came out as a student and then as a registrar and finally said can I take over the practice. Rural generalists must provide general practice, in-patient medicine, emergency medicine, public health and some other special-skill for the community. It bans the boring. You have to protect the next generation. With the doctor that has taken over practice, he spent three years teaching the clinical side of the practice and another three years on how to interact with the health system, interact with management, and have a group of staff. It is important to not be on call all the time. He has looked after his community and they have looked after him. Burnout comes from complete overwork, but it also comes from not being able to express our humanity. They close the practice for half a day every week to talk about their difficult patients, everyone finds that very satisfying. It is important to make sure that the service is equitable across all areas. If you can provide good services then people will stay in rural areas. It is about trying to bring to policy makers the understanding that this is an investment, if they do it well they will have happy people, healthy people, and productive people in rural areas. You’ve got to be there to be heard. It was important to build a collegiate group that could advocate, then getting the rural communities on side and getting the politicians on side. Give the politician the problem, but also provide a solution to the bureaucrat. Then it is about thanking them for recognizing the solution. Recognized that this was going to be a long process. They needed to build an evidence base. It does not come quickly or easily. You need to be persistent and continue to be there. Rural WONCA has developed policies and declarations as well as the Rural Medical Education Guidebook to support rural clinicians. Rural WONCA was established in 1992 as a Working Party on Rural Practice. Top tips: Give it a go. If you don’t try it you will never understand it. Be prepared. You need to be prepared properly for rural practice. If you are not trained for it you will crash and burn. Find a place where you will be supported to learn. Rural WONCA Email: bruce.chater@theodoremedical.com.au Thank you for listening to the Rural Road to Health ! Rural Health Compass…

Rural Road to Health

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Ashley Lambert - Rural Health in Medical Education: RHiME 42:17

vor 15 weeks42:17

42:17

Ashley Lambert is a medical student from the University of Swansea in Wales who is currently on the Rural Health in Medical Education track (RHiME). Episode summary: 01.05 Ashley tells us about her background how she became interested in rural health 02.33 What does she most enjoy about working in a rural area, what does she find most challenging? 08.40 What is RHiME at Swansea University? How is it different from the standard medical curriculum? 17.50 Do they have opportunities to connect with other professions? 19.00 How is she involved in wilderness medicine and does she see it as a part of rural health? 24.30 What has surprised her during her course? 27.45 What makes for a great student rural placement? 34.15 What does she hope her career will look like in the future? Key messages: The best thing about rural areas is the community and the feeling that everyone knows everyone, and the rapport that you have with patients. As a medical student she loves being in a rural area as there are more opportunities for hands-on experiences. However it can be difficult to see patients presenting at a much later stage of their illness. RHiME is the Rural Health in Medical Education track at Swansea University. This track offers rural placements and more of a focus on rural health as well as the undertaking the usual curriculum of medical school. Regular meetings and collaborations such as mountain and cave rescue, working with rural GPs and district nurses, working on social prescribing, talks about farming and opportunities for different placements in rural areas. Wilderness and Expedition Medicine Society has similar aims as RHiME, they encourage people to embrace the outdoors and rural life and to stay in rural Wales. They do a lot of activities, regular group hikes, bouldering, first aid courses, teach people how to tie knots, they also work with rural health doctors and mountain rescue. Wilderness and expedition medicine includes a lot of prehospital emergency care. They have medical teaching in the wild such as C-spine management, hypothermia management, splinting, search and rescue, and ultrasound in the field. The RHiME track has not made connections with other rural medical education programmes, but they would be interested in connecting with other students interested in rural health. The practice made her feel welcome, she was able to sit in with all of the practice staff and see the different way that they work with patients, it was useful to see what all of the different staff did as part of their role. Allowed her to take it at the pace she wanted to and asked her what she wanted to learn. She was given the opportunity to speak with the patient in her own room, make a diagnosis and management plan before discussing it with the GP. The feedback was then very useful for her learning. Swansea-Gambia Link is a project that she has been working on which will support student exchanges between the Gambia and Wales. Contact Ashley: 2204319@swansea.ac.uk Thank you for listening to the Rural Road to Health ! Rural Health Compass…

Rural Road to Health

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Dr Jane George - Recruitment and Retention of Rural Allied Health Professionals 50:00

vor 16 weeks50:00

50:00

Dr Jane George is a health workforce consultant and academic from New Zealand, specialising in rural workforce and the Allied Health, Scientific, and Technical professions. Episode summary: 01.00 Jane introduces herself using a traditional way 03.10 Jane tells her about how she became interested in rural health 07.15 What does she find most enjoyable about rural areas and what she finds most challenging? 12.50 Why did she decide to focus her research on the rural health workforce and allied health professionals? 15.30 What kind of roles do allied health professionals hold? 18.15 Is there a good distribution of allied health professionals? 21.00 What challenges are facing the rural health workforce? 24.10 Do allied health professionals have access to rural based training or rural training pathways? 26.20 What has she learned through her research about attracting and retaining allied health professionals? 28.15 What factors were getting overlooked and why were they important? 31.34 Jane expands on the themes of her research 38.10 What are her top recommendations for local healthcare organizations and for national level policy? 46.15 What is she working on at the moment? Key Messages: The things she loves about being rural are also the most challenging things. Wide scope of practice and the can do attitude. We are never far from the people we serve. Endless opportunities for advocacy. Surrounded by inequity which provides motivation to improve what we do. Opportunities to challenge geographical narcissism. How do we get better at recruiting and retaining the workforce? This was the question she was searching for an answer for. She chose to focus on what matters to allied health professionals to identify what would best attract and retain them. Finding out what made rural work worthwhile. Allied health professions in rural areas can be pharmacist, physiotherapist, podiatrist, occupational therapists, medical laboratory scientist, radiology technicians, social workers and more. It can be difficult to know what the distribution of allied health professionals is across different regions. The government is working on monitoring this better. Service challenges and professional challenges. The amount of travel that is required, isolation of practice, reduced episodes of care available to stay current. Reduced access to professional development, and a constant need to be pushing back against urban narcissism. Social work is a great example of rural based training, as they have been providing distance training for over 10 years. Speech language therapy has recently developed a distance learning program. She developed 20 recommendations for rural health providers, managers, recruiters and regulatory authorities. Shaped through the narratives of the participants and the key themes of her research. Keyt themes were: 1) sense of connection and belonging, 2) safe and supportive practice, 3) creating roles the people want to go for. Negative press, how rural communities are talked about in the media, we are starting to believe what is being said about rural areas - that it is not as good, that people there are not as skilled, that these areas are not well resources… - we can overlook common sense and practical actions we can take. Important to think about how we value and trust staff, how we help them settle and develop local connections. Do the current policies work for local communities and local staff? Are we listening to local communities and staff, what are they telling us they need? Thinking about if what we are requesting of rural health professionals is reasonable, for example, are staff safe if they are visiting places on their own, how long will they need to travel to do their role, are we making professional support and development available. Recommendations for local health organizations: Reality check - think about is this reasonable to ask of our professionals, are we thinking about staff safety, are we designing the work for the context of rural How are you talking about rural areas? Be mindful of urban narcissism, recognize the strengths of rural communities. Represent rural professionals as valuable and knowledgeable. How you treat people will determine if people come and stay. Involve everyone in decision making. Value the learning needs of allied health professionals and make learning resources available. Recommendations for national policy: Making policies and procedures that are fit for rural communities. It needs to be flexible enough to fit rural contexts Involve everyone in decision making Be mindful of biases, use rural proofing tools to check that you are thinking rurally. Use health equity assessment tools. Education policy and regulatory policy is also important for training and regulation professions play a role in developing and recognizing rural professions, advanced practice and rural generalism. Dr Jane George on LinkedIn: https://www.linkedin.com/in/janegeorgenz/ Email: jane@drjanegeorge.co.nz https://www.drjanegeorge.co.nz/ Thank you for listening to the Rural Road to Health ! Rural Health Compass…

Rural Road to Health

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A/Prof Malin Fors - Geographical Narcissism & Potato Ethics 49:11

vor 18 weeks49:11

49:11

Dr Malin Fors is a psychotherapist, author and Associate Professor at the Arctic University in Norway. Her reserach focuses on power dynamics between rural and urban areas. Episode Summary: 01.00 Dr Fors tells us about her professional background and interest in rural health 03. 25 What does she most enjoy about rural settings and what does she find most challenging? 05.45 How are challenges different for people living in rural areas regarding mental health? 09.30 What is “Potato Ethics”? 12.45 How does potato ethics show itself in rural healthcare practice? 15.52 How do new clinicians adjust to rural areas and potato ethics? 19.00 Do the differences in approaches to rural practice indicate where someone might practice in the future? What is the role of medical education? 22.15 What is “Geographical Narcissism”? 24.28 What are the power dynamics that geographical narcissism describes? 32.05 How does geographical narcissism play out in the experience of rural communities? 37.05 How does the concept of having a voice play out in rural areas? 40.00 What are some key insights that she has from her research? 44.50 What is she working on at the moment? Key Messages: Research focused on power dynamics, and became aware that power was not only in the consultation, medical records or encounter, but also in the place. Started to discover that “rural place” was rarely described in text books and missing in the discussion on intersectionality and power. Approaches rural health with a psychology gaze. She met her own geographical narcissism as she had an image of the rural world as different, or inferior or that urban standards were more normative. Enjoys that rural contexts mean you always have to stretch yourself and what you do matters, it is challenging and demanding and feels it keeps her mind sharp and developing. The most challenging is the isolation, feeling alone, feeling like the person that is always teaching and mentoring people that do not stay for long. You can feel like it is useless. It can be frustrating to not have an expert team available. People seem to be more ill when they decide to ask for help in rural areas. They are sicker because there is less healthcare. If you wait, mental health can get better on its own or it can become very serious. Colonization of indigenous peoples' lands in Norway, generational trauma following the second world war, the community is underserved when it comes to healthcare and there is a lack of specialists, this can also contribute to how they present to health services. Potato ethics is the ethics of making yourself useful. In Swedish being a potato means that you are not specialized but that you could be used for anything. It can be used in a condescending way, saying that you are not the expert. She combined care ethics and the ethics of consequences to counter the narrative that we who work in rural areas are less ethical in the way we provide care, not meeting urban standards, working on things we are not specialized enough to do, or treating people that are too close to us. Rural healthcare professionals are potatoes, they are versatile, keep track of patients, do all the tasks that are necessary. We often have to do tasks that are not done in urban areas to prevent disasters. Potato ethics is the core of rural healthcare as this is how it is organized. It is a way to describe the core of rural ethics. It is also applicable to different kinds of healthcare settings. We are assessing consequences, we know that if we don’t treat the person no one else will, so we do what we can. We can not assume that we have sent a referral and now the patient is taken care of. This is not always the case due to distance or availability. We have to make sure we follow up on our patients. Different professionals approach being in a rural area differently. Some people may start to point out errors and try to say how things are done in the city, pointing out what you should do because they can not see that the system is not working for these populations. While others ask “how can I help” because they get it. Geographical narcissism is the subtle devaluation of rural people, rural knowledge, rural experience and rurality. It is a form of oppression like others being addressed within the human rights movement. It is assumed that no knowledge could come from rural areas, can not do research, can not be in the front and that we need to conform to urban ways of doing things. Geographical narcissism is a way to have a term organized around power themes and to put the urban-rural theme under the intersectional lens. It allows us to use the other movements formulations to talk back i,e blaming the victim, aggression and “urbansplaining”. Rural expertise is not thought of as expertise, we are always not reaching the urban standards, however we are often going beyond in a lot of situation. Rural places are seen as being “the other” in comparison to urban places. Talked about almost now one living there, therefore we do not count. Often this is used as a way to explain why we are not entitled to the same services. Rural people are not important enough to get the best care. The idea that anything goes in rural areas, people that can not get a job anywhere else end up in rural areas. Can be explicit sometimes, like when people say if you choose to live rural then you have chosen to have less opportunities or less services available to you. In geographical narcissism there are patterns of devaluation, exploitation, sometimes violence, this is very similar to other types of oppression. When urban experts come to work in rural areas for a few weeks, they can sometimes speak to rural clinicians as if they do not know national guidelines or how to do procedures. Not considering that we may have been involved in developing the national guidance, do research or perform procedures independently. This can be provoking for rural clinicians and they can feel like they are being talked down to and not be seen as equal. When you have a language to name things it becomes more obvious and it is easier for people to become aware about their assumptions. We need to be able to speak with confidence about what we are doing. It is important to not only be angry but to also be open to engaging with people who have a capacity to change. We need to use different strategies to bring awareness and change. Geographical narcissism is also a political question, it is part of discussion about where hospitals should be placed, how many resources communities should be assigned, where schools are positioned and many other things. Urban standards do not always fit in rural areas, ideas about how healthcare should be organized based on urban contexts will not be effective in rural areas as the context is very different. We get told that the rural context is wrong instead of being asked what might work in our context. Rural people are told like all subordinate groups that they are “aggressive” or “will not cooperate” or “silent” and that this is why they are not being heard or listened to. Rural communities represent “counter power” as they have small and subtle ways with which they handle or respond to geographical narcissism. It has been surprising how many parallels you can see between rural-urban dynamics and other human rights issues. Website: https://malinfors.no/en/psychologist-specialist-malin-fors/ Thank you for listening to the Rural Road to Health ! Rural Health Compass…

Rural Road to Health

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Satu Pirskanen - Rural Elderly Care in Finland 33:44

vor 19 weeks33:44

33:44

Satu Pirskanen is a nurse and Project Manager at the Savonia University of Applied Sciences in Finland. Episode summary: 01.05 Satu tells us about her professional background and how she became interested in rural health 03.05 What does she find most enjoyable about living and working in a rural area and what does she find most challenging? 04.12 How is primary care and community care organized in Finland? 08.00 What are the main challenges facing rural communities regarding their health and wellbeing? 12.15 What is the Attraction in Elderly Care Project? 15.30 Which factors were attraction and retention? 16.30 What kind of elderly care is needed in rural communities? 18.35 What other services are used in Finland to support rural populations? 22.08 How has the tool helped with recruitment and retention? 23.41 Are there any interesting projects at Savonia University and are they looking for collaborators? Key messages: Most areas in Finland are rural areas, there are only 9 cities with over 100 000 inhabitants, over 3 million people live in rural areas. Well Being Counties took effect last year in Finland, they organize health and social care services and the financing comes from the state. Municipal health centres provide primary care and they are responsible for GP services, nursing services and maternal and child health services. They also take care of screening and preventative services. One of the core principles of Well-being Counties is that social services are integrated with primary care services. The challenges for rural healthcare: distance to services, shortage of healthcare professionals, longer waiting times and reduced access to care, telehealth access is limited due to connectivity issues or lack of digital skills, aging population with greater needs, mental health issues and social isolation, and economic constraints. Attraction in Elderly Care Project aimed to identify the attraction and retention factors for elderly care staff and develop a tool to help organizations evaluate their attraction and retention factors. Created an Attraction Model which consist of 9 factors: 1) Appreciation, “)Human resources, 3) Flexible working life solutions, 4) Inclusive and supportive staff management, 5) Orientation and student guidance, 6) Functioning and prosperous work community, 7) External communication, 8) Strong professional expertise and work development, and 9) Resource oriented approach to work for the elderly. Limited prescribing for nurses helps with access to certain medications for chronic conditions such as angina and asthma. Transportation services are available for those that have reduced mobility to help them attend medical appointments. Data from the tool shows that many of the factors still need developing at elderly care organizations. PATHS project - for self-management or co-management for elderly care, to support transition to community led care. 13 elderly care teams are progressing towards community management. They are planning to publish a guide about this process. Savonia University: https://www.savonia.fi/en/homepage/ Contact Satu: satu.pirskanen@savonia.fi Thank you for listening to the Rural Road to Health ! Rural Health Compass…

Rural Road to Health

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The Virtual Health Hub - Saskatchewan, Canada 59:56

vor 21 weeks59:56

59:56

In this episode with hear from the team of the Virtual Health Hub in Saskatchewan, Canada: Dr Ivar Mendez, Dr John Michael Stevens, Dr Victoria Sparrow-Downes and Joey Deason. Episode summary: 01.25 Our guest introduce themselves and tell us about their professional background and their interest in rural health 05.26 They share what they most enjoy about living and working in a rural area, and what they find most challenging. 10.15 What is Saskatchewan like? 13.08 What is the Virtual Health Hub? 15.12 How does th Indigenous perspective and culture impact the work of the VHH? 20.17 What does the VHH do? 23.11 How are new technologies used to provide care and support local healthcare teams? 29.15 Are there challenges with connectivity or maintenance of the equipment? 21.10 What other benefits does remote virtual care provide? 37.10 What kind of training is provided to clinicians engaging with the VHH? 40.43 What has the community response been to this new way of working? 49.08 What are some of the lessons that they have learned from working on the VHH? 55.35 What are the first steps to move towards developing virtual care? Key messages: Saskatchewan is the size of France with 30% of the population being rural and remote. There are many opportunities to leverage technology to improve care for rural and remote populations. Some of the challenges are: lack of resources, being away from family can be difficult, access to patients or patients accessing care, harsh climate, logistical challenges. Most enjoyable part of working in rural and remote areas is being part of a tight knit community and healthcare team. The climate is harsh, especially in the winter with temperatures up to -60C. Many of the communities are not accessible by road and can only be accessed by plane. Due to isolation there are other challenges such as access to food, some communities may only have one small general store with limited access to fresh produce. Some of the communities are 900 km away from tertiary care centres, it can be a three hour flight to reach them. This can be a barrier to healthcare provision. The Virtual Health Hub is an Indigenous led project as most of the communities it serves are Indigenous. It is a purpose built building which will have access to state of the art technology to allow clinicians to assess patients in real time and help them make a decision on the triage and treatment of patients. It is a project supported by the governments. It aims to serve about 90 communities. The Indigenous perspective is crucial in the development of the work of the Virtual Health Hub. Indigenous culture plays a role in how clinicians approach care and there is great value in having people who are familiar with the different cultures providing care through the virtual system. Projects of the VHH are primarily informed by each community's needs. They are looking to harness the strengths of local community members and seeing how they can be involved in providing care. Developed an applied certificate course which is designed to train healthcare workers from the community on how to work with new virtual care technologies. This enables them to work better with clinicians that are providing virtual care. VHH has been working with remote communities and a number of issues are clear from this work: Accessibility to timely care. Local healthcare workers can feel like they have to practice beyond their scope of practice Challenges to recruitment and retention Advanced technologies allow clinicians to support the local team and the triage of patients when it is needed. The virtual system has been able to save lives. They have very high quality video and audio connection to other clinicians which is useful for critical cases where specialist input may be required. Clinical services are provided from a distance, a remote clinic can be performed entirely via video link where patients can connect with a clinician. VHH is piloting some new technologies to see if they work in rural and clinical settings. Telerobotical ultrasonography is a project that makes ultrasound available to rural and remote communities. The ultrasonographer is in a central location, on the other side there is a robotic arm with an ultrasound probe allowing them to perform scans remotely. This has been crucial for prenatal ultrasounds. They have developed a partnership with the local telecommunications provider to ensure that they have the required connectivity and bandwidth for their service. Most of the systems being used can be maintained remotely, are reliable and can function well for long periods of time. There is a bolstering effect for recruitment and retention in these communities, the availability of remote support helps to build confidence and reassurance knowing that acute cases can be managed with a shared responsibility model. There is a large gap between telephone support and having the possibility of having an specialist see what is happening and the situation in the room and have your hands free to take action. One of the challenges of virtual care is the inability to perform a physical exam. This has been addressed by developing a virtual health hub assistant training course. These assistants would be based in the community and be able to perform some guided physical examinations. Virtual care done in the right way has the ability to increase accessibility, continuity and quality of care. They encourage a team based approach to virtual care with sharing of expertise and responsibility which builds trust and capacity. They have been working to understand patient pathways and how this can be integrated into the workflow of different clinicians. Part of their role is to make a system that is easy to use for the patients and communities as well as the clinicians and care providers. They have a technical team that provides training to support them in working with the VHH. Virtual care is about building trust and relationships. When communities receive access to healthcare they embrace the technology. They are looking to see how to incorporate translator services as different communities use different languages. Another challenge is enabling the use of virtual care for people with hearing impairment or other disabilities. Lessons learned: The importance of building solutions with the community. You have to be flexible and malleable in your vision - be willing to change what your project is or what you think you are working towards. Focus on the needs of the communities rather than fitting your ideas into the communities. Remain open minded to all possibilities. Some technologies may have been piloted in very different circumstances than they might be being used in a rural or remote setting. Trust and relationships with the community really drive successful projects. Virtual care is a new frontier and there is an underdevelopment of protocols or guidance. This development needs to be done. Advice for First steps: Understand the community and their needs. Do not underestimate the challenge of bringing virtual care into the workflow of clinicians. Be prepared for a huge project. Research is important, backing up your work with scientific evidence is important when you are trying to take new technologies and mainstream them. Collect evidence, identify what is and is not valid. Virtual Health Hub: https://virtualhealthhub.ca/ Contact VHH: info@virtualhealthhub.ca Thank you for listening to the Rural Road to Health ! Rural Health Compass…

Rural Road to Health

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Prof Janessa Graves - WWAMI Rural Health Research Centre 47:38

vor 22 weeks47:38

47:38

Prof Janessa Graves is the Director of the WWAMI Rural Health Research Centre at the University of Washington. Episode summary: 01.00 Janessa tells us about her professional background and how she became interested in rural health. 03.44 What do you enjoy most about living and working in a rural area and what do you find most challenging? 07.45 What is her rural community like, what are some of the characteristics of this area? 11.25 What are the challenges for healthcare in rural Washington? 14.19 How is rural health research organized and funded in the USA? 19.35 What is the WWAMI Rural Health Research Centre? 22.53 Janessa tells us more about a few of the research areas that WWAMI is working on. 29.03 What are some insights from your research that could apply to different rural communities? 32.20 How is the research feeding into policy making? 35.25 How is the diversity of rural places reflected in the research and policy? 39.57 Are there programmes that are gathering data on other rural issues such as information technology and transport? 43.30 Are you working on projects that you are looking for collaborators on? Key messages: There are fewer degrees of separation between people and places where you live if you're in a rural community, it generates meaningful connections and relationships between people. The most challenging part is limited access to services, technology and experiences. Most of the urban centres, and most of the population in Washington lives west of the Cascades and then east of the Cascade Mountains there are expansive plains. 17 % of the population lives on 70% of the land mass. There are limited economic opportunities in rural areas and there is limited healthcare access. There are long distances to get to services, and there are also provider shortages. Weather impacts access to services, particularly with long distances and snow in the winter. Research is funded by federal agencies, National Institute for Health and Agency for Healthcare Research and Quality. The Federal Office of Rural Health Policy funds rural health research in the US, it was founded in the late 1980s. It focuses on issues impacting healthcare in rural America. The Rural Health Research Centre Program was established in 1988 to do rigorous objective health services research that is of interest to the national sphere and to help inform policy makers and the public with evidence to support rural healthcare. There are a number of Rural Health Research Centres around the US, they focus on different issues and cultivate researchers that are specialized in rural health research. The WWAMI Rural Health Research Centre, represents Washington, Wyoming, Alaska, Montana and Idaho, the states in the North West US. The research that it does is national in perspective. The areas of focus are rural health workforce, training of primary care providers in rural communities, substance use, behavioural health and mental health services in rural communities. Communities can come up with creative solutions to some of the challenges that they face. They need to be supported in accessing resources and capacity that may not be available locally. Rural Health Research Gateway makes all of the findings of Rural Health Research Centres available to all. This can be found at https://www.ruralhealthresearch.org/ Public health and research often does not integrate the geographic component, which is so important, so doing the descriptive work on access to services or prevalence of mental health illness in, in rural versus urban communities or looking at substance use in adolescents in rural, across rural areas is still needed. All the work done at the Rural Health Research Centres is relevant to policy and policy makers. It can have a direct impact on policy and rural communities. It is important to have good representatives and empowered voices advocating for rural communities. National Institute of Occupational Safety and Health has a program on total worker health, which is not just about industrial hygiene or preventing injury at the workplace or workplace disease and illness, but also looking at shift work and access to healthy foods and this idea that it's not just a worker but that it's their total health and wellness that's important. Contact Prof Janessa Graves: janessa@uw.edu WWAMI Rural Health Reserch Centre: https://familymedicine.uw.edu/rhrc/ Thank you for listening to the Rural Road to Health ! Rural Health Compass…

Rural Road to Health

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Dr Bethan Stephens & Dr Katie Webb - Longitudinal Integrated Clerkships in Wales 1:09:43

vor 24 weeks1:09:43

1:09:43

Dr Bethan Setphens, a GP and Director of Community Learning at Cardiff university, and Dr Katie Webb, a psychologist, and a Professor of Medical Sducation at the University of Cardiff, tell us about Longitudinal Integrated Clerckships in Wales and the upcoming CLIC conference. Episode summary: 01.30 Katie and Bethan tell us about their professional background and how they became involved with medical education. 04.26 What is a Longitudinal Integrated Clerkship? 08.22 How were LIC introduced in Wales? 11.29 What were the challenges of establishing this new approach to medical education? 15.43 What are some important features of LIC and how do they enhance medical education for students? 21.15 How are communities involved in LIC? What role do they play in the student’s education? 23.55 What is social accountability and what role does it have in LIC? 26.53 What impact have LICs had on student’s future career choices? 34.15 Are there benefits for the GP practices that engage with LICs? 49.45 What is the Consortium for Longitudinal Integrated Clerkships? What is CLIC 2025? 56.11 What are the topics and themes for the CLIC 2025 conference? 01.05.00 What are their hopes for outcomes from CLIC 2025? How do they see LICs developing in Wales? Key messages: Longitudinal Integrated Clerkships (LIC): Consists of comprehensive care of patients over time while based in one community. Students that are involved have continuing learning relationships with patients, clinicians, and they meet most of their academic clinical competencies across multiple disciplines simultaneously through these experiences. A number of universities in the UK have started offering longitudinal Integrated clerkships. In Wales the government supported the establishment of LIC, it first started in Aberystwyth and Bangor. Cardiff University has been running the program since 2018. Their students are mostly based in primary care. They develop longitudinal relationships with supervisors, the community and patients. They started as a way to try to tackle challenges with recruitment and retention of GPs in rural areas. Getting initial buy-in from staff and students can be a challenge. However, the learning outcomes for students have been found to be the same as for those on the standard curriculum. Features of the LIC: students spend a whole year in one practice and in one community, social learning, having access to a team of professionals not just one mentor, continuous learning which improves the learning cycle, builds confidence and students become more independent and they develop a deeper understanding of the social and health system context. Students develop a sense of belonging during their time in the community. This can lead to a feeling of responsibility for the community. Many of them choose to help during COVID with patient care and vaccination programs. Students live and work in the area for the year and join different community activities. They work on a student selected project, this project often looks at providing a new service or evaluating an existing service. Social accountability in LIC means that the student thinks about how to co-produce things with the community, gets them thinking about what the community needs and how to meet those needs through working with the community. There have been around 30 graduates to date from their program. Around half of those have opted during their time to stay in Wales. They have expressed interest in staying in the same area or working in another rural area, others have changed their career preference towards general practice. Indications at this early stage are positive. Information about CLIC 2025: https://www.cardiff.ac.uk/community/events/view/2871539-consortium-of-longitudinal-integrated-clerkships-clic-conference-2025 Thank you for listening to the Rural Road to Health ! Rural Health Compass…

Rural Road to Health

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Prof. Karen Flegg - Rural Health Leadership 44:55

vor 25 weeks44:55

44:55

Professor Karen Flegg is a rural general practitioner from Australia and the current president of WONCA, the World Organization of Family Doctors . Episode summary: 01.04 Karen tells us about her professional background and her journey into rural health. 04.20 What has she most enjoyed about living and working in a rural area and what does she find most challenging? 07.50 What has her rural leadership journey been like? 14.30 How did she go from a rural doctor in Australia to the president of WONCA? 19.15 What are some of the challenges that she has faced during this journey? 24.45 Do some of the challenges prevent rural doctors from taking up leadership roles? 26.19 What does taking up a leadership position bring to your rural practice or rural area? 28.50 Is it important for younger colleagues to develop leadership skills? 34.15 How can rural clinicians advocate for their communities and what are some lessons that she can share? 37.10 What would she like to see for the future of family medicine and rural practice? Key Messages: The experience of having great supervisors and mentorship in a rural environment. Colleagues stick together, provide advice and do some communal thinking on difficult problem Most enjoys the community, knowing neighbors, and the community spirit. Challenges can be the social situation, the difficulty of finding friends rather than just people that are friendly. As the new doctor was invited to join the board of the community information centre, this was her first experience as a chair of a board. Had an opportunity to join the board of the Australian College of General Practitioners, the reality was not what she expected. Realized quickly that she needed a mentor. She did not actively seek leadership roles, sometimes you just say yes. Applied to be the WONCA editor and held this role for 10 years. Through this role she got to know many people from all over the world. During that time also stood for WONCA executive. Being a rural doctor has helped as it was important to have a broad understanding of what family doctors do all around the world. Living in a place that had easy access to an airport and good internet access was an important consideration for an international leadership role. A challenge can be understanding governance to effectively chair a board. She actively sought to learn about governance and business skills. Concerned about planetary health, however, as WONCA president has to travel as part of her role. Balancing leadership with clinical roles can be difficult particularly with recurrent trips overseas. She has found a part time role that is flexible and this is not always possible for everyone. She had a break from some of her roles due to other commitments, the location where she was living and other circumstances at the time. There is an element of excitement in the local community when you hold a regional, national or international leadership role. The community is interested in what the local doctor is doing. Young rural clinicians should say yes to opportunities. Getting involved in different WONCA working parties and special interest groups is one way to do this. If you can go to a conference, present something. In 2025 there are WONCA regional conferences in April for the South Asia region and Asia Pacific region, and the World conference in Lisbon in Portugal in September. There are Young Doctor Movements in each world region that colleagues can get involved in. The networking is the best thing about conferences. Networking is part of leadership, the opportunity to meet people and have a chat with someone from a completely different part of the world and learn from each other. If you are going to advocate for your community it is important to get a team around you and networking in the community to understand different views within the community. Someone might be better fitted to lead advocacy efforts and it might be that the family doctor works in the background. Leading from behind - mentoring other people, delegating to others who might be better suited to the task, networking and having a team of people who are involved. It is lonely being a lone ranger. She would like WONCA to be the go-to organization to advise on primary care and family medicine. Rural workforce issues are most concerning. Rural communities and rural doctors are aging. She is keen to give medical students exposure to rural practice and rural training. WONCA has a special interest group for policy advocacy. They are thinking about leadership and advocacy. There is also a young doctors leadership program that has been launched recently. There are many opportunities to step up and get involved in leadership. WONCA conferences: https://www.globalfamilydoctor.com/Conferences.aspx WONCA working parties and special interest groups: https://www.globalfamilydoctor.com/groups.aspx Young Doctor Movements: https://www.globalfamilydoctor.com/groups/YoungDoctorsMovements.aspx Thank you for listening to the Rural Road to Health ! Rural Health Compass…

Rural Road to Health

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Dr Chris Rice - Nurse Recruitment & Retention on the Scottish Isles 37:25

vor 26 weeks37:25

37:25

Dr Chris Rice is a qualified nurse and paramedic, and Associate Head of Postgraduate Medicine at Edge Hill University in Lankashire. His doctoral thesis explored the recruitment and retention of nurses staff across northern Scotland’s non doctor islands. Episode Summary: 01.30 Chris tells us about his professional background and how he became interested in rural practice. 03.25 What does he most enjoy about working in a rural area and what does he find most challenging? 04.57 What are the health services and the population like in Shetland? 10.45 Why did he choose to research recruitment and retention of nurses on the Scottish Isles? 12.05 What are the skills and competencies that nurses need to work on the Scottish Isles? 17.19 How is the infrastructure on the islands? 19.00 What are the opportunities for training or professional development on the Scottish Isles? 21.10 What were the insights that he had from his research on recruitment and retention? 24.33 What factors play a role in retention? 27.37 What are younger nurses not choosing to come to the isles? 29.45 What are his recommendations for improving recruitment and retention of nurses? 34.30 What is he working on currently? Key Messages: The biggest reward is holistic patient care, getting to know the patients, becoming part of the community, and a sense of belonging which is unique to rural practice. Challenges - being on-call 24h a day, being the only medically trained person on the island. NHS Shetland covers a population of about 22 000, there are about 5 no-doctor islands, they are remote and accessible by boat, plane or helicopter. Population on these islands varies from 15 to 450 members of the community. Depending on the weather it can be challenging to transport patients off an island, they collaborate closely with other emergency services and they have equipment on the island to help them manage critical patients when needed. The healthcare professionals on the ground on the islands are usually nurses who are there 24h a day, living on the islands, provided with accommodation and transport. Patients are linked to a local GP who may or may not be based on the island. What drove him to move to the Scottish isles? He wanted new challenges for his practice, delivering continuity of care and being part of the community. He wanted to understand what drove others to make a similar decision. A variety of skills are needed, primary care, emergency care and chronic disease management. There is always somebody at the end of the phone, there is always a GP on-call, an advanced practitioner or emergency services. Ultimately you still need to make the clinical decision for the patient in front of you. Provided with trauma and emergency training and the Sandpiper trust provides training and a bag with emergency equipment. The majority of nurses came to the isles for a change of career, they were looking for something different. Many of them came to the isles ahead of retirement. The majority were over 50 yrs of age. The nurses were from A&E, GP or acute medicine backgrounds. Work-life balance was a key factor for retention of nurses. The community finds work for partners of those coming to work on the isles. Younger professionals are more focused on building a career and this can be easier in more urban areas. The younger generations tend to go off island to get the experience and build careers and then they return later in life. It is important to have an open and honest dialogue about what the job is and what to expect. There are new training pathways being developed for rural and remote practice. Contact: ricec@edgehill.ac.uk Thank you for listening to the Rural Road to Health ! Rural Health Compass…

Rural Road to Health

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Susanne Tegen - National Rural Health Alliance 50:53

vor 28 weeks50:53

50:53

Susanne Tegan is the CEO of the National Rural Health Alliance in Australia and an advocate for rural communities. Episode summary: 01.15 Susanne tells us about her professional background and how she developed her interest in rural health. 06.00 What does she find most enjoyable and most challenging about living in a rural area? 12.50 What is the National Rural Health Alliance? 17.55 How did the membership organizations come together to form NRHA? How did that aid advocacy efforts? 21.20 What are some of the main challenges facing rural Australians when it comes to their health and wellbeing? 28.05 How is the NRHA trying to address some of these challenges and what is their role? 35.50 How does the NRHA work with others outside of the healthcare sector? 41.15 What will the NRHA be focusing on over the next few years? Key Messages: Addressing population health needs, and dealing with solving problems when you don’t have all the ingredients you need. Lucky to have amazing space outside of the city, gives you peace of mind and time to reflect and think. Sun up and sun down, smells, bird sounds, it really centres you. People pull together after disasters, sterling examples of innovation and resilience. The hypocrisy of rural people being seen as “hicks” as they may not look like they are well educated. Two thirds of Australia’s export income comes from rural, remote and regional Australia and so does 90% of the food that Australians eat, and they bring in 50% of the tourism income. Rural people make up 30% of the population (7 million people). Everything is more expensive, the “tyranny of distance” places stress on individuals, businesses and communities. Rural communities are more sensitive to economic downturns. In Australia people are dying 12-16 years earlier in rural and remote areas than in the cities. The National Rural Health Alliance (NRHA) is a non-profit, funded by membership fees and the federal government. An agency with 53 members, entities that work along the patient journey or in health workforce education pathways. Supports researchers in rural Australia. Geographical narcissism where we have a belief that if something is developed or driven by the city it must be good, but if it is driven by people on the ground that its second rate. It isn't, but it's different and it may need different funding models. NRHA looks at increasing the understanding of issues facing rural health, workforce shortages, socioeconomic needs of rural communities, they advocate for collaboration based on values and need driven with the community being part of the development of initiatives. NRHA reminds the government that taxpayer money which is to be used to meet the needs of the citizens. NRHA is now 35 years old, in 1991 the first National Rural Health Conference was held in rural Queensland. NRHA has been promoting working together of national and federal governments and advocating for a national rural health strategy. Rural Australians are sicker and are dying up to 16 years earlier. More than 50% of rural doctors are international medical graduates. Revolving door of clinicians, doctors, nurses and allied health professionals, many communities are feeling let down and not supported. From research of government funded programs, rural Australians are getting AUS$6.55 billion per annum less spent on them, this is about $850 less per person. Rural and Indigenous students are much more likely to return to their rural and remote communities to work after graduation. Big issues: workforce, population health needs, underfunding and inflexible funding, multidisciplinary care, possibilities, governments working together and seeing the importance of governments working with communities. NRHA is on a number of ministerial committees who are involved in setting policies and providing feedback from the grass roots. NRHA participates in state and federal senate inquiries and they provide submissions for questions relating to rural health and rural communities supporting their members to provide evidence and asks aligned with shared goals. NRHA works closely with other industries based in rural communities as they are important for the health and wellbeing of those communities. The value chain is not just health. NRHA has asked for AUS$1 billion over 4 years and 50% of that to be block or blended funding for those communities and regions where the market has failed to support infrastructure and the other 50% to go towards health services. We need to do something differently as we now have the data and know that inequalities exist. What will NRHA be focusing on over the next few years? 1) Australian National Rural Health Strategy this includes the AUS$1billion fund, 2) building a community of practice through developing a Rural Health Hub, 3) closing the gap regarding Aboriginal health access, 4) working with communities for disaster planning and resilience, 5) supporting clinician wellbeing, 6) advocating for more funding for rural research, and 7) international community of practice. NRHA website: https://www.ruralhealth.org.au/ Email Susanne Tegen: susanne.tegen@ruralhealth.org.au Thank you for listening to the Rural Road to Health ! Rural Health Compass…

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