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HealthSpeak issue 16 • August 2016



page 15


NCPHN Lead Site for mental health


10 news

Aged care

25 update

What is

29 Feldenkrais?

New Health & LIfestyle section Head Office 106-108 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Vahid Saberi Email: enquiries@ncphn.org.au Hastings Macleay 53 Lord Street Port Macquarie 2444 Ph: 6583 3600 Cnr Forth and Yaelwood Sts Kempsey 2440 Email: enquiries@ncphn.org.au Mid North Coast 6/1 Duke Street Coffs Harbour 2450 Ph: 6659 1800 Email: enquiries@ncphn.org.au

editor Janet Grist


elcome to the August issue of HealthSpeak with a special feature on getting to grips with MyHealth Record

Tweed Valley 145 Wharf St, Tweed Heads 2486 Phone: 07 5589 0500 Email: enquiries@ncphn.org.au

Contacts Editor: Janet Grist Ph: 6627 3300 Email: media@ncphn.org.au Clinical Editor: Andrew Binns Email: abinns@gmc.net.au Design and illustrations: Graphiti Design Studio Email: dougal@gdstudio.com.au Display and classified advertising at attractive rates HealthSpeak is published three times a year by North Coast Primary Health Network. Articles appearing in HealthSpeak do not necessarily reflect the views of the NCPHN. The NCPHN accepts no responsibility for the accuracy of any information, advertisements, or opinions contained in this magazine. Readers should rely on their own enquiries and independent professional opinions when making any decisions in relation to their own interests, rights and obligations. ©Copyright 2016 North Coast Primary Health Network Magazine designed by Graphiti Design Studio www.gdstudio.com.au Printed by Quality Plus Printers

HealthSpeak is kindly supported by


Dr Chris Ingall turns his pen to the topic of coffee. And Clinical Editor Dr Andrew Binns shares his knowledge about the benefits of high intensity interval training – I’ve heard he can be spied climbing the stairs near his work for his high intensity workouts at lunchtime. Suggestions for topics for our new section are welcome, and if you’d like to submit an article, I’d love to hear from you!

The Long and Winding Road

Northern Rivers Tarmons House 20 Dalley Street Lismore 2480 Ph: 6627 3300 Email: enquiries@ncphn.org.au

Health Speak

in your practice and an update on aged care. Also in this issue, we have a new four-page section at the back of the magazine devoted to Health & Lifestyle. In our first spread, we have an informative article from Anna Huddy of the Health Promotions Unit at NNSWLHD about those high caffeine, sugar loaded ‘energy’ drinks kids are often seen consuming and the impact on health.

ceo Vahid Saberi


ecently I had breakfast with Mr Chris Crawford, the just retired long-standing Chief Executive of the Northern NSW Local Health District. In the course of our conversation about health care home, I highlighted the importance of bilateral (NSW State and Commonwealth) agreement to implement integrated care and “bend the curve” on health costs – which I thought was pertinent. Chris reacted to this in an animated manner, unlike his usual calm and steady style. He commented that this is looking at the issue from the treasury lens. “We should not make the argument about good health care a financial one. The value should be about providing the right care at the right place. If good care is provided, where it should be provided, the system will improve and the cost curve will bend as the result.” I found Chris’s observation instructive and insightful. It is true that somehow this discussion often lands in the finance terrain and becomes about reducing costs rather

than improving care. Talking about better health care, the concept and strategy of Health Care Home, aka Medical Home, has gained quite a bit of media attention and no doubt will be headline for many symposiums and conferences in the coming months. The Commonwealth in response to the recommendations from the Primary Health Care Advisory Group is trialling the Health Care Home pilot. The intention is to trial a payment methodology that incentivises caring for the whole patient which the current fee for service MBS payment methodology does not encourage or incentivise. The pilot will be implemented in seven, yet to be announced, Primary Health Care regions. The target population is those over the age of 45with two or more chronic conditions. Stage one of trials, commencing on 1 July 2017, will include 200 general practices and 65,000 patients. The patient enrolment is voluntary and the patient will choose the clinician to coordinate their care. This is an important trial and the Government should be congratulated. Payment arrangements do influence care. Where the payment rewards fragmented episodes of care – that is what will be delivered. At the same time, it is also important to recognise that the

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Commonwealth trial only targets one dimension of a multidimensional task. Transforming the healthcare system is a major change management process that requires action on many fronts, time, and a shift from rewarding volume and throughput to rewarding value and outcomes (from the patient’s perspective). The objective of the Health Care Home is transformation of the health care system to one that is person-centred, joinedup and delivers accessible, equitable, high quality, integrated care. Dr Tony Lembke sums it up this way – “In a person centred health system, each person and their family can access the care team that they need, that team is of high quality, and care is experienced as 'joined up’”. This team is their care home, they know the team, the team knows them, they can access them when they need them, and that team grows to incorporate members of the wider healthcare neighbourhood as required by the patient. The transformation road ahead is long and winding, yet there is much room for optimism. As Chris Crawford put it, the argument should not be about the cost curve but right care. We all should not forget this fact and ensure that the argument does not become a financial one. healthspeak August 2016

Ice epidemic – is it really?


recently attended North Coast Primary Health Network’s travelling educational talk on the use of crystal methamphetamine or ice. It was pleasing to receive a more professional airing of this topic than we sometimes hear via the media. The tabloid media like to ‘beat it up’ but what are the real issues behind the hype? On a cursory look at the figures, the ice issue is small in numbers compared with alcohol related problems. Amphetamine use and abuse has been around for decades, so what’s so concerning now? The answer lies in the purity and potency of the product now on the market. The crystal form is readily available and when smoked or injected is much more potent than the previously used powder or base forms of the drug. In addition, the use of crystal meth is increasing significantly compared with other forms of amphetamines. According to the National Drug Strategy Household Survey 2013, only 2.3% of Australians over the age of 14 used amphetamines during the past year and only half of this number used the crystal form ice. This compares with 86.2% that used alcohol – numbers that have not changed significantly over 10 years. These figures also show that 75% of amphetamine users take the drug infrequently – around once a month. Those who are regular users (once per week) are the biggest concern with potential dependence, severe mental health problems, sleep and nutritional deficits and self harms. The incidence of poly-drug use is also high with cannabis and alcohol being the most common among ice users. Crystal methamphetamine affects three neurotransmitters in the brain, serotonin leading to feeling good and connected; noradrenaline leading to alertness, concentration, increased energy; and dopamine leadAugust 2016 healthspeak

ing to reward, motivation and pleasure. As the dose and usage increases, the initial euphoria, alertness, reduced appetite and increased sex drive can lead on to nervousness, agitation, teeth grinding, jaw clenching, nausea, hot and sweaty, vomiting and headache. In severe cases there can be chest pain, breathing problems, tremor, seizures, confusion, disorientation, muscle rigidity, panic and psychosis, many of which may lead to a hospital presentation. Possible long term effects are physical such as seizures, heart failure, stroke, kidney failure, cardiac disease, extreme weight loss and malnutrition. Dental problems include extreme dry mouth, severe tooth decay, gum disease, poor oral hygiene and effects of teeth grinding. Psy-

Motivational interviewing, cognitive behavioural therapy, support groups and a healthy lifestyle are important in recovery treatment

chological and cognitive effects are common, including memory problems and psychosis. The social consequences are significant disruptions to individuals and their families including criminal activity. Managing intoxication can be challenging and it is important for carers to stay calm, non judgmental, listen and respond appropriately, allow personal space and be clear in their communications. Avoid confrontation. Withdrawal from ice is difficult and lengthy with various stages in the process. There is an initial crash with prolonged sleep, increased appetite, irritability, feeling flat, dysphoric and anxious. Then there is a phase with mood swings, agitation, anxiety, sleep disturbance, poor concentration and memory, strong cravings of hunger and thirst and suicidal thoughts. In the longer term, which may take 18 months, there are still strong cravings, poor concentration and memory and an inability to experience pleasure. The good news is that affected people can recover from crystal meth dependence. And the 75% of methamphetamine users using less than once per month can eventually quit without major

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clinical editor Andrew Binns problems. There are no designated medications for treatment and counselling, although motivational interviewing, cognitive behavioural therapy, support groups and a healthy lifestyle are important. For those who have a past history of major trauma such as adverse childhood experience, there needs to be culturally sensitive trauma informed care available. Family and community support and understanding are vital for a successful recovery. It is often the most vulnerable young people in our community who become addicted to ice, particularly those whom have suffered trauma. There is concern that the potential for ice addiction will become an increasing public health problem. What’s much needed is a regional residential facility for long term rehabilitation plus better understanding by the community and health professionals of the issues surrounding the use of ice.


Finalists selected for Excellence Awards


welve finalists have been shortlisted for the Inaugural Primary Health Care Excellence Awards hosted by the North Coast Primary Health Network (NCPHN). The awards evening will be held in Coffs Harbour on September 9. “These new Awards showcase the excellent work being done by GPs, allied health practitioners and community health workers right across the North Coast, from the Tweed down to Port Macquarie,” said the NCPHN’s Chief Executive Dr Vahid Saberi. Three finalists were chosen in each of the four Award categories with project topics ranging from the health of mothers and babies/young children, improving the wellbeing of disadvantaged people, and the eVillage in Byron Bay/Bangalow connecting Feros Care residents

with GPs, specialists and the community. Several of the projects focus on Indigenous health, including the 1 Deadly Step exercise program in Casino and the early detection of chronic kidney disease. The finalists are: 1. Tresilian Lismore Family Care Centre - Enabling

Service Provision through Partnership

2. North Coast Primary

Tweed event connects GPs and specialists


n late June, NCPHN in partnership with John Flynn Private Hospital hosted an evening based on the speed dating format for GPs to meet specialist colleagues in an informal atmosphere. Seventeen specialists and 12 GPs took advantage of the event to get to know each other. NCPHN GP Adviser Dr Brett Lynam said often GPs or specialists receive correspondence or phone calls from colleagues they’ve never met – but work in the neighbourhood. “It’s really helpful to put a face to the name, and the evening also enabled colleagues to catch up with others they know but rarely meet,” he said. During the night, the doctors were able to ask questions about special interests,


These Awards spotlight the often unseen efforts that help make improvements to health care outcomes in nonhospital settings Health Network (Mid North Coast) - No Longer on the

Backburner: Re-Developing Musculoskeletal Models of Care

3. NCPHN, NNSWLHD, Bulgarr Ngaru, UCRH, Solid Mob and NSW Country Rugby League - 1 Deadly

Step, Casino

4. New Access - New Access


5. Nimbin Neighbourhood & Information Centre Inc - Nimbin Independent

Services (NIS)

6. NCPHN - Needs Assessment 7. New Directions - Mothers

& Babies Program

8. NNSWLHD Renal Services and Bugalwena General Practice - Early Detection of

Chronic Kidney Disease in Aboriginal People 9. NCPHN - Improved Health from the Winsome Health Outreach Clinic in Lismore 10. NCPHN - First Responders CPR Program

11. Bay Medical Centre, Byron Bay, Feros Care - eVillage 12. MNCLHD, Royal Far West & NCPHN - Nambucca Val-

ley Healthy Kids Bus Stop

“The Primary Health Care Excellence Awards honour the partnerships, teams and individuals who work tirelessly to find new ways to keep community members healthy and out of hospital,” Dr Saberi said. “These Awards spotlight the often unseen efforts that help make improvements to health care outcomes in non-hospital settings. Not just the finalists but all of the 40 accepted entries are winners in their own way, although the true winners are the patients and clients whose health and wellbeing is benefiting from the efforts of our wonderful health care professionals,” he added. For more information go to: http://ncphn.org.au/excellence/

New owner for Nimbin Medical Centre

O Tweed Speed networkers

training, referral pathways, consulting rooms and clinical questions. The networking evening involved specialist colleagues from the Tweed Hospital – both staff specialists and VMOs, and John Flynn Private Hospital specialists on one side of the tables. GPs from Tweed Valley catchment were on the other. side.

n August 1, the ownership of Nimbin Medical Centre was transferred from North Coast Primary Health Network (NCPHN) to Dr Vinay Potumuthu of McKid Medical, Kyogle. The medical centre will continue operating with the same doctors and services. The transfer of ownership comes after a change in the role of Primary Health Networks. Nimbin Medical Centre first opened its doors in 1982 and has been run by North Coast Primary Network (and its previous entities) since 2003. It is a unique and enduring medical

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centre with a history of tremendous community support. North Coast Primary Health Network would like to thank the Centre’s doctors and practice staff for their service to the community over the past 13 years. We wish Dr Vinay all the best as the new owner of Nimbin Medical Centre. healthspeak August 2016

Clinical Council Symposium: communication and integration


CPHN’s first Clinical Council Symposium was held in June in Coffs Harbour to bring together all the GPs involved in the three clinical councils set up by NCPHN across our region. The Symposium gave participants an understanding of the Primary Health Network’s vision, structure and priorities for the next 12 months. GPs were invited to provide input into the topics of Commissioning, Learning and Developing and LHD Integration Priorities. The three Chairs of the NCPHN’s Clinical Councils – Dr Adrian Gilliland (Mid North Coast), John Vaughan (Hastings Macleay) and Peter Silberberg (Northern Division) facilitated the sessions with presentations from NCPHN Chair Dr Tony Lembke, Chief Executive Vahid Saberi, Tracy Baker from MNCLHD, Clinician Engagement Manager Monika Wheeler and GP Clinical Adviser Dr Dan Ewald. Chair of the Hastings Macleay Clinical Council, Dr John Vaughan, said the symposium was a refreshing chance for primary care practitioners to come together and to reflect on ways to work together. “Working together we can try to improve the quality and efficiency of primary care delivery across the North Coast. The Symposium was a positive and energising experience for us all, allowing us to see from different perspectives how we can all contribute to a better and more positive outcome for our patients. “It was particularly heartwarming to have such a diverse group representing general practice, allied health and Aboriginal health at the meeting.” In John’s opinion, the key to improving health outcomes is through much improved comAugust 2016 healthspeak

Often people assume that communication will happen on its own, but resources must be available to enable the building of networks and relationships NCPHN's Coffs Harbour Clinical Council Symposium attracted GPs from all over the North Coast

munication not only between health practitioners, but also between the hospital and community health sectors. As Clinical Council Chair I see my role as a facilitator between various primary health practitioners and also as a bridge to the hospital sector in our district. Remaining positive in the face of the many obstacles is one of my main aims, as well as welcoming and including allied health and Aboriginal health practitioners into the Council,” he added. Dr Adrian Gilliland, Chair of the Mid North Coast Clinical Council, said he’d welcomed the opportunity to meet other council members at the Symposium. He saw two main things come out of the gathering, the need to focus on integration and improved communication between health professionals. “The PHN has a key role to link together the different silos that currently exist in healthcare. It’s important that we get the different components of the health system talking to each other and working together,” he said. Adrian is also keen to see the resources needed put into improving communication. “Networking is required for

people to get to know each other and it requires trust. That takes time to build and it takes resources. Often people assume that communication will happen on its own, but resources must be available to enable the building of networks and relationships. You need these

relationships before you can expect outcomes.” Adrian became Chair following his experience as Primary Care Clinical Adviser to the Wellington District Health Board in New Zealand. “In that role I was a key integrator across primary and secondary care and we made significant progress. I would Continued page 12

Nursing students a boon for general practice


lstonville Clinic recently hosted two SCU nursing students for placements to give the students a taste for the work of practice nurses. Alstonville Clinic Practice nurse Kim Eggins said that students sometimes assumed that not much went on in general practice, but she said at Alstonville Clinic patients often presented at the clinic rather than go to Lismore or Ballina to hospital. “We get patients turning up with heart attacks and other acute conditions, so our students get a broad range of experience in dealing with patients,” she said. One student came on

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placement when Kim’s two PN colleagues were on leave and her presence was much appreciated. “Jennifer Schultz came on a work placement when I was here on my own and having an extra pair of hands really made a difference. Some students aren’t suited to general practice but Jennifer was terrific and we’re keen to hear from her when she finishes her studies.” SCU would like to place more nursing students in general practice. If your practice is interested contact Michael Grande at michael.grande@ scu.edu.au


NAIDOC WEEK 2016 NAIDOC Week celebrates Aboriginal and Torres Strait Islander heritage, culture, arts, and achievements and recognises the significant contributions that Indigenous Australians make to our country. This year’s theme was Songlines: the living narrative of our nation. Songlines speak of the Dreamtime - a

community spirit in both places, and we felt very privileged to be involved. I most enjoyed engaging with the kids who went away with new knowledge about making good health choices,” said Claire Malseed.

time when the earth, people and animals were created by our ancestral spiritual beings. In 2016 Australians were invited to explore the Songlines in their local region, and to explore how they connect people to country, and country to people. NCPHN’s Aboriginal health team attended more than 20 NAIDOC events this year.

Coffs Harbour

Tweed Heads

Here NAIDOC celebrations commenced with the official flag raising and church service at Minjungbal Museum, ending with the traditional street march down Wharf Street and a corroboree in Jack Evans’ boat harbour. The Aboriginal Health team took part in the Health & Sports Day held at Arkisnstall park, South Tweed attended by around 250 Community members. The team at Tweed for the NAIDOC Sports Day

Byron Bay

The day began with a street march through Johnson St into the Denning Park area, overlooking the beach. In addition to running a health information stall, the NCPHN team also worked with a nurse from a local medical centre to offer free blood pressure and blood sugar checks. Lismore & surrounds

Kids performing at the Tabulam Community Day

Staff from Hastings/Macleay at the Kempsey NAIDOC Day march


The Aboriginal Health Team attended nine community events, including Bonalbo, Casino, Lismore, Tabulam, Grafton, and Kyogle, promoting programs including Mums and Bubs groups, diabetes information sessions, and supermarket tours. Highlights included the Lismore Council event that included exhibitions and stall from more than 50 local organisations and services. The team particularly enjoyed travelling to Bonalbo and Tabulam. “There was an impressive

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In Coffs Harbour the Aboriginal Health team hosted a Men’s day in Nambucca Valley offering haircuts, massages, and lunch, a Women’s gathering in Macksville offering crafts and beauty treatments, and a Family Fun day in Nambucca Heads. These events were hugely successful with over 300 locals attending. Community members and Elders groups also attended the Planting the Seed event at Diggers Beach Reserve in Coffs Harbour, where NCPHN partnered with National Parks and Wildlife Service and a bush tucker tour was enjoyed by about 50 people. Hastings Macleay

There were events in Kempsey, Port Macquarie and Wauchope. Family fun days in both Kempsey and Port proved popular and around 130 people completed a health survey, with 39 requesting a call to talk about how to improve access to health services. At South West Rocks there was a BBQ and picnic sponsored by NCPHN with games and sand modelling competitions. The team also attended flag raisings in Kempsey, Port Macquarie, and Wauchope and collaborated with other services, including Durri Aboriginal Medical Service and Bunyah Land Council in Wauchope to sponsor morning tea after these events. A community event was held at the Port Base Hospital featuring Aboriginal dancers and singers as well as a BBQ and health information stalls. Golf days in Port and Kempsey completed the activities. healthspeak August 2016

North Coast a ‘Lead Site’ in mental health


he North Coast Primary Health Network (NCPHN) is delighted to announce that it has been selected as a Lead Site to test models of care in the roll out of the national mental health reforms. A key focus of this work will be services for people with severe mental illness and complex needs. NCPHN is one of 10 Primary Health Networks around Australia selected through application to be a Lead Site for the reforms. The focus of the Lead Site work h will take place from 2016 to 2019. Tailored care

The ‘Stepped Care Model’ is central to the reforms announced late last year. Under the stepped care model, primary mental health services (those delivered outside of hospitals) will move

August 2016 healthspeak

towards an approach where care suits individual needs, rather than a ‘one size fits all’ approach. Primary Health Networks will be in charge of commissioning the mental health services considered necessary and appropriate to meet the needs of local communities. For example, decisions about the youth mental health services required in a local community will now be made by that local community, not Canberra. Suicide Prevention

As part of the reforms, North Coast Primary Health Network will be overseeing the implementation of a system-wide approach to suicide prevention to meet local needs. Indigenous Australians

More funding will be available

for NCPHN to provide greater access to mental health services for the Aboriginal and Torres Strait Islander population. NCPHN’s Director, Mental Health Reform and Integration, Dr Megan Lawrance, said as a Lead Site, North Coast Primary Health Network would be a champion and pioneer in primary mental health reforms. “We’ll be testing models of coordinated care for adults with severe mental illness and complex needs. Implementing a systems approach to suicide prevention will also form part of our work. “Working alongside consumers, carers and health professionals, NCPHN will lead the development and modelling of innovative approaches to stepped care in mental health,” said Megan.

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Research into early alcohol sips A survey of 2000 Australian families has found that 60% of 13 year olds have had a sip or taste of alcohol. However, researchers at the University of NSW also found that it was not the early sip of alcohol from parents that led to young people abusing alcohol, but other factors such as peer pressure or exhibiting rule breaking behaviour. Lead author Dr Monika Wadalowksi said her research will be tracking the children over the next four years. She said early findings suggested parental supply was just one factor influencing future drinking habits.


Health Pathways update Lung Cancer Pathway The Lung Cancer HealthPathway provides localised assessment, management and referral information for the Mid and far North Coast region. Background

Lung cancer is projected to account for 3,210 deaths in NSW in 2020¹ and accounted for over 20% of cancer deaths in NSW in 2012. Incidence continues to climb in females while falling in males. Survival rates are improving for those recently diagnosed with lung cancer and it is clear that lung cancer will affect our communities for a long time despite the current success of smoking prevention and cessation programs. Lung cancer symptoms can be non-specific and masked by other diseases. Lung cancer is prevalent in rural and disadvantaged communities resulting in statistically poorer health outcomes. Project

Cancer Institute NSW provided funding to Northern NSW Local Health District to participate in a pilot project to map the current referral pathways for patients

with lung cancer in the region and define an optimal pathway for management and referral. The project had secondary aims of developing a cancer pathway development toolkit that could be used across NSW for lung and other cancers. The project team used clinical improvement methodology to engage key stakeholders in primary and specialist care to work iteratively and collaboratively in defining the optimal care pathway for the region. Pathway

There is no national consensus about screening for lung cancer. Symptoms and signs that prompt assessment for lung cancer include a persistent cough, change in cough or haemoptysis. The Lung Cancer Pathway identifies respiratory physicians that attend multidisciplinary cancer care team meetings as the optimal first point of referral for patients with suspected or early stage cancer. They are identified within the Lung Cancer Pathway along with other cancer team members including medical oncologists, radiation oncologists and cardiothoracic surgeons. Any of the specialists are available to be

contacted regarding where the initial referral should be made. Next steps

The Lung Cancer Pathway will be continually assessed for accuracy and relevance to local needs. It provides an effective tool for general practitioners by clearly identifying the local services available and the optimal steps to assess and refer patients. Information on the Lung Cancer Pathway has been presented to staff of Aboriginal Medical Services and to local Clinical Society meetings with more presentations to follow. Over time the Pathway will Check it out! View Mid and North Coast HealthPathways localised for our region: https://manc. healthpathways.org.au/ Username: manchealth Password: conn3ct3d

be expanded to include optimal treatment options, supportive care and follow up recommendations. ¹Cancer statistics, Cancer Institute NSW, 2016.

Chronic Hepatitis C update The new Direct Acting Anti-viral drugs are now available for GPs to prescribe when a specialist service gives approval. This usually does not require the patient to be seen by the specialist. The new treatment regimens have significantly higher cure rates (95%), better tolerability and simple dosing regimens, better accessibility, shorter duration. The HealthPathways Chronic Hep C pathway has been updated to guide GPs through these changes.

Networking in Grafton connects professionals


The organisers behind the networking evening. From left: Rachel Gorman, NCPHN; Dr Marion Tait; Amanda Chircop NCPHN; Steve Brierley, CEO St Vincent’s Hospital; Leah McCarthy, St Vincent’s Hospital and Monika Wheeler, NCPHN.


partnership between NCPHN and St Vincent’s Private Hospital in Lismore resulted in a very informative speed networking event in Grafton in June where specialists working at St Vincent’s travelled down to meet local GPs. Leah McCarthy, Executive Assistant from St Vincent’s, approached NCPHN about running an event in Grafton following a similar successful networking night by the PHN in the Northern Rivers. Thirteen VMOs from St Vincent’s met the Grafton based doctors in a relaxed atmosphere at the

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Vines at 139 café which was hired specially for the evening. “GPs are quite nomadic and there can be a high turnover in regional areas,” Leah told HealthSpeak. “We were keen to let Grafton GPs know what specialist services are offered here at St Vincent’s and for them to meet the specialists face to face.” The feedback from both specialists and GPs was very positive and Leah is looking at jointly organising another similar event with North Coast Primary Health Network for the hospital’s VMOs in Ballina.

healthspeak August 2016

Launch: Centre for Healthcare Knowledge

Can schizophrenia be reversed?


une 15 marked the launch of an exciting new arm of North Coast Primary Health Network – the Centre for Healthcare Knowledge & Innovation. The Centre aims to stimulate and grow innovation in the region. It will bring national and international scholars to the North Coast to share their knowledge with the local health and social services workforce, fuelling innovation and creativity. One of the first scholars invited by the Centre was Dr Nick Goodwin, co-founder and CEO of the International Founda-

tion for Integrated Care in the UK. Dr Goodwin took part in the launch at Byron Bay and led a workshop focussed on the integration of healthcare. North Coast Primary Health Network’s Chief Executive Dr Vahid Saberi said he hoped the Centre would be an inspiration and driver of healthcare improvement across the Australian East Coast. “The new centre will host a range of experts to foster discussion and engagement around new models of working in healthcare, innovation and novel ideas,” he said.

study has shown that the brains of patients with schizophrenia have the capacity to reorganise and fight the illness. Schizophrenia is associated with a widespread reduction in brain tissue volume. However, research has found that a subtle increase in tissue also occurs in certain brain regions. The study followed 98 patients with schizophrenia and compared them to 83 patients without schizophrenia. The team used Magnetic Resonance Imaging and an approach called covariance analysis to record the amount of brain tissue increase. This had not been demonstrated in patients before now. According to Lawson Health Research Institute's

Dr. Lena Palaniyappan, there is an overarching feeling that curing people with a severe mental illness, such as schizophrenia is not possible. This comes from a long-standing notion that schizophrenia is a degenerative illness. "Our results highlight that despite the severity of tissue damage, the brain of a patient with schizophrenia is constantly attempting to reorganise itself, possibly to rescue itself or limit the damage," she said. The study, "Dynamic cerebral reorganization in the pathophysiology of schizophrenia: a MRI-derived cortical thickness study" was published online in issue Psychological Medicine, 26 May 2016.

The NCPHN Practitioner Newsletter – your fortnightly source for networking and educational events. Separate editions covering Tweed Valley, Northern Rivers, Mid North Coast and Hastings/Macleay. Also in the electronic newsletter: • • • • •

Specialist medical topics Latest HealthPathways Latest resources linked to the NCPHN website MBS/PBS & immunisation updates New health services & clinicians

Not subscribed? Go to http://ncphn.org.au/practitioner-newsletter/ NCPHN’s Practitioner Newsletter is the primary source of information to general practice.

August 2016 healthspeak

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Immunisation news Specialist immunisation advice line

ganise a telehealth consultation, call the clinic on 1800 679 477).


Issues with reporting dosages

he NSW Immunisation Specialist Service (NSWISS) has been set up to provide clinical advice and support to immunisation providers on complex issues. Specialised nursing and medical staff from the National Centre for Immunisation Research & Surveillance at Westmead Children’s Hospital are available to provide advice on immunisation for patients with complex or unusual medical backgrounds. They also provide advice on adverse events following immunisation. NSWISS operates between 9 am and 5 pm Monday and Friday. For all other immunisation clinical advice call your Public Health Unit on 1300 066 055. What does NSWISS provide?

• Assessment and management of a child or adolescent who has previously experienced an adverse event following immunisation • In-depth consultation with parents who have vaccination concerns - side-effects and possible adverse events • Administration of vaccines under close supervision, if appropriate • Follow-up by telephone call after vaccination • Outline of schedule options for future vaccination (which may differ from the standard schedule depending on the nature of the adverse event experienced) • Vaccination under sedation for children unable to be vaccinated in the community setting • Telehealth consultation • Phone advice and referral for adults to an appropriate specialist according to the concern or adverse event experienced To arrange a referral or to or-


There are issues with providers reporting 18 month DTPa (Infanrix or Tripacel) and adolescent dTpa (Boostrix/Adacel). To clarify, children born on or after 1 October 2014 will need five doses of DTPa and it is populated automatically for children on the Australian Childhood Immunisation Register (ACIR). These children are funded for the additional vaccine under the National Immunisation Program. Children born before 1 October 2014 only need four doses of DTPa and are not funded for an additional dose of DTPa at 18 months of age. When reporting a DTPa dose on an electronic medical record or directly on to the ACIR, remember the DTPa given at 18 months must be reported as the fourth dose and not first. This is also applies for adolescents receiving a booster dose of dTpa at 12 years of age. Note what the last DTPA dose given in childhood and record it on your electronic medical system as the next consecutive dose. Therefore if the last know dose was dose 4, you must record the dTpa as dose 5. However; if a child born before 1 October 2014 receives a fourth dose of DTPa before their 3 ½ year old schedule dose, this must be recorded as a repeat dose 3. Recording this as dose 4 will remove a child 4 year DTPa due for a child. If the DTPa/dTpa dose is recorded incorrectly to ACIR, the child will be classified as overdue. This will affect parents/ carer who receives the child care benefit, child care rebate and/or Family Tax Benefit Part A. Australian Immunisation Register

From the 1 September 2016 the Australian Childhood Im-

munisation Register becomes the Australian Immunisation Register (AIR). Vaccinations administered to all ages will be registered on the AIR. If your facility does not have access to online ACIR, now is the time to act. Any facility with a provider number can obtain access to the ACIR. If your facility doesn’t have a provider number; go to

the online form and details: https://www.humanservices. gov.au/health-professionals/ services/medicare/australianchildhood-immunisation-register-health If you have a provider number, request access through the ACIR site https://www1.medicareaustralia.gov.au/ssl/acirCIRGRACC

HealthPathways topics in this issue


elow are the HealthPathways topics related to health topics found in this issue of HealthSpeak. COPD

• COPD Assessment • Management of COPD • Preventing Deterioration in COPD • Optimising Functioning in COPD • COPD Support Networks • End state COPD management • Medications in COPD Immunisation

• Immunisation – childhood • Immunisation – adults • Influenza immunisation • Immunisation – adolescent • Pertussis vaccine for pregnant women

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• Adult Audiometry Assessment • Asymmetrical Sensorineural hearing loss • Otitis Media with Effusion (Glue ear) • Newborn hearing screening & intervention • Child Audiometry Assessment • Tinnitus Methamphetamines

• Drug & Alcohol Services • Alcohol reduction • Drug & Alcohol Services

Login to find these topics View Mid and North Coast HealthPathways localised for our region: https://manc. healthpathways.org.au/ Username: manchealth Password: conn3ct3d

healthspeak August 2016

Substance Misuse Update


ince April NCPHN has run Community Conversations on the topic of crystal methamphetamine (ICE) in Grafton, Casino, Tabulam, Maclean, Ballina and Lismore. These events have all been well attended with lots of questions from the community after the presentations given by NCPHN staff members and other community members, such as police and representatives from Aboriginal health and community organisations. Out of each of these meetings, Working Groups have been developed and each is working on the issues identified as important to address the ICE problem in the various regions. For instance, in Lismore the main actions identified were • Support for families • Innovative ideas for detox and withdrawal – option for home and ambulatory detox programs • Campaign around real life ice users – to reduce the shame of users and to change the stereotypes of ICE users • Look at ways to lessen discrimination around users and their interactions with community In Casino and Evans Head, the Working Groups identified actions as organising more rehab programs and finding opportunities for youth to address their boredom which often leads to drug experimentation. The community is keen to find ways to build resilience in their youth. Substance Misuse Training

A year long Substance Misuse Training program has attracted more than 30 Expressions of Interest from community and health organisation staff in the Coffs Harbour region. NCPHN Program Manager, Christine Minkov, said that the aim of the training was to August 2016 healthspeak

Smart Recovery Groups

These groups are an alternative to NA and AA. Smart Recovery Groups are peer-based support groups based on a CBT model for behavioural change. NCPHN staff have run two trainings and now 16 people are trained to be facilitators for this program. Two more trainings will happen in September. Then 32 trained facilitators will then be available to run these Smart Recovery Groups.

Communities are keen to find ways to address youth boredom which often leads to drug experimentation

Climate Schools

empower people working in a variety of organisations to effectively work with clients presenting with a drug and/or alcohol problem. “The people training are generalist case workers, so you might have them working in Housing, Juvenile Justice, an employment service, headspace etc. The case workers often find that their clients’ use of substances is getting in the way of them achieving their goals. Goals such as getting into housing, going to school or finding a job,” said Christine. Participants are taught how to engage with the client, screen them on potential misuse problems and work with them using some low intensity Cognitive Behavioural Therapy interventions. These include identifying that the person has a problem in the first place, goal setting, and identifying the triggers that result in substance misuse.

have been trained to deliver GP specific training on the topic of crystal methamphethamine. Fourteen sessions have been held from Tweed to Grafton at lunchtime for general practice staff. All have been well attended and staff found the sessions informative and useful.

LOOKING FOR SOME NEW WHEELS? Lismore’s Southside Health and Hire Centre (in association with Southside Pharmacy) have a large range of quality BARIATRIC and standard equipment for hire or purchase including shower chairs, lifters, electric beds, wheelchairs, seating, walkers, commodes and more.

Workforce Development Programs


NCPHN has tailored intensive training around ICE and provided this training to a number or organisations including the Family Law Court, OTCP, psychologists at the Department of Education, and counsellors at Southern Cross University. GP Specific training

NCPHN Practice Support staff

An online Drugs and Alcohol program for high school students, Climate Schools is delivered in the classroom by the Personal Development teacher. Each lesson plan costs $950 for one year. NCPHN has funding available to pay for all schools in the region to deliver this innovative program. Already 16 schools have signed up.

Call us today on (02) 6621 4440 or come in and say hello at 5 Casino Street, South Lismore. Southside Health & Hire Centre Where your health is our total concern.

Nurse on Duty www.southsidehealthandhire.com.au

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8:30am - 5pm Mon - Fri 8:30am - 12:00pm Sat Closed Sunday


From page 5

now like to help to improve the Australian health care system particularly in my new home, the Mid North Coast,” he added. Chair of the Northern Region Clinical Council, Dr Peter Silberberg, sees the lack of integration between health services as a recurring and significant problem in Australia and one that the clinical councils are well placed to work on. “Lack of integration leads to poor health outcomes, inefficiency and sometimes has terrible consequences for patients. Specific examples include inadequate information transfer between providers leading to huge monetary and time wasting – an inefficiency our health

system can no longer afford. “Fortunately the federal and state governments appear to be getting on board the integration theme. An example of the federal commitment has been the establishment of the Primary Health Networks across Australia and the clinical councils have been established as part of this structure to provide clinical guidance to the PHN. “To this region’s credit, there are many hard working people in our health sector who believe in integration and want the system to improve. I hope that my role as the chair of the Northern Clinical Council can in a small part help contribute towards this long term and vital goal,” Peter told HealthSpeak.


Melanomas falling in younger folk While skin cancers account for the largest number of cancers diagnosed in Australia each year, the good news is that for people under 40 the rate has dropped, from 13 cases per 100,000 people in 2002, to about 9 in 2016. The Australian Institute of Health and Welfare (AIHW) report, Skin cancer in Australia, estimates that almost 13,300 new cases of melanoma will be diagnosed in Australia

in 2016, with about 1,800 people dying from the disease. “Since 1982, the rate of melanoma in the population has almost doubled-up from 27 to 49 cases per 100,000 people,” said AIHW spokesman Justin Harvey. Public education campaigns on the effects of sun exposure may be related to the reduction in melanoma for those aged under 40. The report also shows that survival from melanoma is relatively high, with people diagnosed in 2007–2011 having a 90% chance of surviving at least five years.


Exchanged Traded Funds – What are they? By Michael Carlton CEO & Senior Adviser, PECUNIA

share. You can buy or sell ETFs at any time throughout the ASX trading day. Market liquidity for ETFs is maintained by ‘market-makers’ who ensure that buy and sell prices are quoted continuously on the ASX.

Private Wealth Management

What is an ETF? An Exchange Traded Fund (ETF) is a diversified portfolio of securities constructed using an index approach that can be readily traded on the Australian Securities Exchange (ASX). Investors in Vanguard ETFs own a share of a portfolio of listed securities, indexed by Vanguard. As an index manager Vanguard’s aim is to deliver the index return, before fees, by building investment portfolios using similar assets and weightings as the benchmark index - we don’t try to pick winners from losers. This means an ETF’s returns, before costs, should closely match the index it tracks, just like a traditional index managed fund. ETFs deliver two benefits to investors - the trading speed and flexibility of shares merged with the low-cost, diversification of index funds. This has made ETFs one of the fastest growing investment solutions in the world today, with hundreds of billions of dollars invested in ETFs globally.


How ETFs work An ETF is a sharemarket-quoted fund that comprises an investment portfolio of shares, bonds or property securities. Through purchasing a single ETF share, investors gain access to this portfolio. ETFs are constructed using an indexing approach, so their value moves in line with the index they track. For example, a 2% rise or fall in the index would result in approximately a 2% rise or fall for an ETF which tracked that index. Buying an ETF share is an easy, fast and low cost way for investors to own a slice of that underlying portfolio and benefit from changes in its value. ETFs are bought and sold on the ASX through a broker, like any other

a publication of North Coast Primary Health Network

The structure of ETFs ensures this investment generally trades close to the Net Asset Value (NAV). The NAV is the underlying total value of net assets divided by the number of units on issue. As ETFs are quoted investments, a ‘share registry’ manages the administration for investors such as confirming settlement, providing distribution and tax information. For further information see our website: www.pecunia.com.au Important information and disclaimer This publication has been prepared by Michael Carlton, an Authorised Representative (AR No: 239724) and Carlton Family Trust ABN 51 283 954 577 t/a PECUNIA Private Wealth Management a Corporate Representative (CAR No: 1233485) of Dover Financial Advisers Pty (AFSL No: 307248). His advice is general in nature and readers should seek their own professional advice before making any financial decisions.

healthspeak August 2016

Dr Peter Silberberg: Following his passion


he past 12 months has been a time of great change for Northern Rivers GP Dr Peter Silberberg. Until last year, Peter enjoyed two fulfilling roles – one as a GP at Lennox Head and the other as an educator at North Coast GP Training (NCGPT). Sadly, NCGPT closed its doors in 2015, leaving a big hole in Peter’s working life. “It was a great opportunity to have a creative outlet outside of medicine, creativity in the way you presented information to the registrars and it was really rewarding watching people learn. The best thing as a teacher is when you watch the penny drop and see someone get something for the first time or maybe change their behaviour for the better,” he said. Peter first worked in this region in 1999 and worked locally for a while, in between completing his training as a GP and junior doctor. He also did some public health research in the Northern Territory. “I was based at Darwin and did a stint at Alice Springs, my first experience working in an Aboriginal Medical Service. “That was a great experience I loved it. I learned heaps and enjoyed meeting the unique population that lives there.” For a few years Peter and his family went back to his home town Melbourne. There he did GP work, including working with an organisation looking after youth with drug and alcohol and mental health issues. In 2008 he returned to the Northern Rivers. It’s clear that Peter is a man with an appetite for change. “When NCGPT closed, that was challenging, but one of the great things about medicine and especially general practice is that when one door closes, another one opens.” His change in circumstances meant that Peter has been able to get back into an area of health August 2016 healthspeak

Would you like to work at Jullums? Lismore Aboriginal Medical Service is looking for GPs who have experience in working in Aboriginal health or have a desire to get some experience in this interesting field. Anyone interested in the opportunity, should contact Greg Bishop at gbishop@ncphn.org.au

Peter is enjoying his work in Aboriginal health

he’s passionate about – Aboriginal Health. “I’ve been at Jullums [Lismore Aboriginal Medical Service] since March and I’m really loving it. It’s definitely different to mainstream general practice. Our patients are the first custodians of our country, but unfortunately are highly disadvantaged. The history of service provision to Aboriginal people is not great in Australia and so you feel like you are part of an organisation that is trying to change that experience. Jullums is a place where Aboriginal people can feel safe and access easily. That’s really fulfilling in itself, apart from the medicine which is generally pretty interesting as well. It’ a privilege to serve this community,” said Peter. This year, Peter has also become Chair of the Northern Regional Clinical Council at North Coast Primary Health Network. What made him take on this role? “I guess deep down a desire to be part of change. The goals of the PHN are good ones, trying to integrate our health system. While it’s a huge challenge, it’s something we definitely need to be doing. I think everyone

The PHN has a mandate to create change and that’s really encouraging. But it does take time and we need to be patient agrees with that, it’s just about how we get there." Being Chair of the Clinical Council also allows Peter scope to look at the broader picture,


Rosacea & dementia Rosacea is associated with an increased risk of neurological disorders such as Alzheimer’s disease and dementia, according to a large population study. Danish researchers studied nearly 5.6 million adults and found those with rosacea had a 25% increased risk of Alzheimer’s disease and a 7% increased

a publication of North Coast Primary Health Network

aside from the minutiae of general practice. “Working clinically and on the clinical council is a great balance. We need to get all the players talking to each other, all the stakeholders, the LHD and other community providers and go from there. There’s tremendous goodwill in this region. “Everyone knows what the problems are and people have for decades have been constrained by the system and that’s led to a lot of burnout and throwing your hands in the air. But the PHN has a mandate to create change and that’s really encouraging. But it does take time and we need to be patient. If we try to rush these things and look for changes too quickly, we’ll fail.” risk of dementia compared with those who did not have the skin complaint. Rosacea sufferers aged 60 years and over were at the higher risk end and women with rosacea had a slightly higher rise of Alzheimer’s than men. The researchers point to rosacea’s association with increased levels of metalloproteinases and antimicrobial peptides that are also implicated in neurological disorders such as Alzheimer’s disease and dementia.


Awards for organ donation research


n Honours research thesis highlighting the barriers to organ donation has earnt Emily Sharpe a Southern Cross University Medal and an award from the Australian Psychological Society for academic excellence. Emily, Zoe Moore and Prachi Batra, who all completed the Bachelor of Psychological Science with Honours, were awarded the University Medal at the Coffs Harbour graduation ceremony in June. Emily, who moved to Coffs Harbour from Sydney to complete her Honours year, said she was very excited to receive the awards. “It was a really good year. My supervisor Dr Gail Moloney was amazing. The staff really wanted us all to succeed and they really pushed us,” Emily said. Her thesis titled ‘The Effect of Attitudes and Registration Opportunity on Organ Donor Registrations’ found that while there was high societal support

Emily Sharpe and Prachi Batra receiving awards at the Southern Cross University Honours Psychology Research Conference in 2015. The pair will both receive University Medals on Saturday.

for organ donation, this had not translated into registrations on the Australian Organ Donor Register. “I found that a lot of people have conflicting attitudes about organ donation and registration. There are a lot of misconceptions that make it hard for people to commit to signing the

register,” she said. Through her study Emily found that when people were offered an immediate opportunity to register, as opposed to a delayed registration, they were much more willing to commit. Emily hopes her research leads to more Australians on the Organ Donor Register.

NNSWLHD Nurse & Midwife Awards HealthSpeak congratulates Northern NSW nurses Sandy O’Brien and Josie Bates, who have been recognized for their outstanding service through two awards. Sandy, Integrated Care CNS1– Mental Health/Drug & Alcohol Services & Integrated Care Program, won the Jane Ackerman Memorial Award for Clinical Excellence. Sandy works between Tweed and Lismore with NNSWLHD, general practice, the North Coast Primary Health Network and AMSs to build relationships, communication channels and collaborative working arrangements. Sandy has been an important collegiate link between North Coast Primary Health Network and LHD staff in driving integration improvements. Josie, NUM Surgical 1/Orthopaedics at The Tweed Hospital, won the Meryl Brown Memorial Award for Outstanding Achievement in Midwifery Management.


Looking to upgrade your Medical Software? Terry Daniel and Leonie Kennedy owners of TeeDee Computers have partnered with BP Software to assist businesses with changing over from their existing software program to Best Practice, or upgrading their current Best Practice Software. Terry and Leonie are based on the Mid North Coast and have existing clients stretching from the Northern Rivers to Port Macquarie and Adam (Terry’s son, based in the Blue Mountains) has clients in Newcastle, Sydney, Wagga Wagga, Melbourne and WA! “We have a passion for the industry, it’s always changing and it’s a great way to meet fantastic people. We travel wherever the client needs us – we are here to help you!” The team have been in business for almost 25 years and have a strong knowledge base across a variety of medical software programs. We are very excited to be associated with BP Software and the ongoing developments they are undertaking to enhance their products for GP’s, specialists and Allied Health.


Setting the standards in clinical management software for doctors, Best Practice was created by Dr Frank Pyefinch, pioneer of clinical software in Australasia. TeeDee computers are proud to be associated with the newest offering from Best Practice-Bp Premier. The finches of the Galapagos pointed Darwin to the theory of evolution. The soaring finch logo is Dr Frank Pyefinch's personal guarantee that BP Software will continue to evolve in response to the particular needs of Australasian doctors. Based in the Queensland regional city of Bundaberg but with office locations in Sydney, Brisbane and Hamilton (NZ),

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Best Practice Software develops, markets and supports quality software products for Australasian medical practice. Best Practice was launched in 2004 by Dr Frank Pyefinch who brought to the company not only the benefits of a career as a busy General Practitioner but also more than a decade’s experience as a pioneer of medical software development in this country. Best Practice has remained true to its founding principles of supporting doctors, evolving to meet the changing needs within Australasian healthcare. Best Practice have now released its long awaited upgrade and changed the name to “Bp Premier”. This is a major revision of their GP software especially in the area of administration and reporting. So, if you are considering changing your software, give us a call. We look forward to hearing from you. Kind Regards Terry Daniel – 0418 656 133 Leonie Kennedy – 0477 641 033 Website: www.teedee.net.au

healthspeak August 2016

n mid July more than 3.8 million people had registered for the My Health Record system following the addition of almost a million new records in the two opt-out trial regions earlier in the month. The consumer view of the system has also undergone a complete revamp both in terms of the user interface and ease of use. The home page view now lists the person’s shared health summary, personally entered notes and advance care information, with clinical documents accessible through drop-down menus. After years of false starts and grappling with privacy and confidentiality issues, the federal government launched the revamped My Health Record (MyHR) in March this year. All Australians can register for a MyHR and have access to a summary of their personal health information whenever they need it.

STOP PRESS MyHR now mobile friendly The MyHR system is now accessible on mobile devices and will shortly reach the milestone of four million consumers registered, Health Minister Sussan Ley said in late July. Addressing the Health Informatics Conference Ms Ley said the platform was now mobile accessible allowing patients and health professionals to access their record anywhere at anytime.

POTENTIAL IMPACT Federal Health Minister Sussan Ley claims that if all Australians signed up to MyHR, around 5000 lives could be saved a year. It could also help avoid two million primary care and outpatient visits, 500,000 emergency visits and 310,000 hospital admissions. Benefits of shared health information: • Provides a more complete view of patients’ health • Provides access to medical information that you might not otherwise have • Includes allergies, drug reactions and medication history • Includes prescribed medications and discharge summaries • Can lead to improved clinical decisions • Fewer adverse events for patients and fewer avoidable hospital admissions • Better health outcomes • Complements but does not replace local clinical records • Can be valuable when treating patients with a range of healthcare providers and those with complex health conditions • Helps care for patients who don’t have a regular doctor or travel to receive health services

August 2016 healthspeak

• And, if your data has been maintained, a Shared Health Summary can be created in two clicks!

TRIALS OF MYHR USING THE OPT OUT METHOD Earlier this year, Federal Health Minister Sussan Ley announced the start of two trials of MyHR in North Queensland and in the Nepean/Blue Mountains area in NSW. This trial will include the automatic creation of electronic health records for more than a million residents to improve coverage rates using an opt out system, reversing the previous opt in system. Residents of the trial, which runs to the end of the year, have received a letter about the trial and information on how to opt out if they wish. The trial will run until the end of the year.

GP INCENTIVES FOR REGISTERING General practice is being encouraged to register and use MyHR through the revised

Practice Incentives Program (PIP) eHealth incentive. Eligible practices can receive a maximum payment of $12,500 per quarter. The new eligibility requirement is for general practices to contribute shared health summaries to the MyHR system for their patients. General practices will be required to upload Shared Health Summaries for a minimum of 0.5% of the practice’s standardised whole patient equivalent to be eligible for the PIP eHealth Incentive payment.

MYHR AND PHARMACY – IS IT READY? The Federal Department of Health has stated that around 65% of community pharmacies have dispensing software compatible with MYHR. However, on 3 July 2016, there were 1,219 of the 5500 retail pharmacies across Australia registered with the MyHR system. In the opt out trial areas, at the end of March, 19 North Queensland pharmacies had registered, and six in western Sydney. President of the Pharmaceutical Society of Australia Joe Demarte said that while progress with digital health had been slow, pharmacies needed to register with the MyHR system. Pharmacy’s IT technology is also catching up. One pharmacy software specialist Fred IT will trial its MedView Medicines Workspace during the later stages of the North Queensland trial. Fred IT CEO Paul Naismith said that in the early stages the new software would allow pharmacists to do medicine reconciliations by giving them access to medicines information from a variety of sources. This information would also be available to hospital clinicians and GPs, and eventually would be able to inform the MyHR itself. Pharmacies with software able to connect to MyHR can register online at: www.nehta.gov.au Once registered, pharmacies need to contact their software vendor to complete the connection process. Contact NCPHN’s Digital Health officer Tony Browne on 6618 5405 for assistance in registering with MyHR.

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Tony Browne has a background in IT, focusing on how systems, processes and people work together more effectively. Project management has been a big part of Tony’s background and he spent a number of years in Queensland Health in among a number of government and private IT organisations across south east Queensland. Tony’s really looking forward to the challenge of improving the ease of access and quality of information for both patients and health practitioners through the uptake of MyHR across the region. “My Health Record is a thing that everyone should have. It’s even more important than a Facebook account,” he said.


Rachel Roy, Practice Nurse at Banora Shopping Villiage Medical Centre

B NCPHN CAN HELP North Coast Primary Health Network staff are working with general practice to support them in registering their practice and patients for My Health Record. For individual attention and assistance and help with any aspect of My Health Record, please contact your support officer on 6618 5405. The team has also created some easy to understand pages about registering for and using My Health Record on the NCPHN website. View them at: http://ncphn.org.au/digitalhealth/


anora Shopping Village Medical Centre Practice Nurse Rachel Roy told HealthSpeak that two years ago when she tried to register patients with the then Personally Controlled Electronic Health Record (PCEHR), she was confused and dismayed by the amount of paperwork and time required. But recently with the help of NCPHN’s general practice support officer, Kelli Babovic, Rachel has become a My Health Care Record ‘champion’. She said it takes only around 30 seconds per patient and generally she registers six patients a day. “Kelli has been just terrific. She has encouraged me and if I have a query I just email her and she gets back to me usually within half an hour. I’d encourage any practice to make use of their general practice support team to help register patients.” Rachel said that the Medical Centre had come up with a system of registering patients that was quick and easy and could be done within other appointments. “We’ve written an email to all our doctors, reminding them to broach the question of My Health Record with each patient they see. “The doctors ask patients for their permis-

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sion and go through the various checks before giving me their names and I go through the process of logging the patient’s consent and adding them to the system,” she said. With a great many patients over 75 and without access to computers or smartphones or iPads, Rachel takes the opportunity to ask patients about My Health Record when doing health care plans or health assessments. “That’s when I publicise the electronic health record with them, giving them a flyer to read if they want to know more. It’s all about convenience for them as many don’t have transport and can’t easily get to the Medicare office. “So if the patient is sitting with me, I can show them what I’m doing and they can consent to what’s in front of them on my computer screen.” On the day I visit, Rachel has seen four patients already and all four have agreed to register. She said she’s only had a couple of patients who were concerned about sharing their information and how it would be used. Rachel shared some tips on using My Health Record.

SO IF THE PATIENT IS SITTING WITH ME, I CAN SHOW THEM WHAT I’M DOING AND THEY CAN CONSENT TO WHAT’S IN FRONT OF THEM ON MY COMPUTER SCREEN. RACHEL’S TIPS • Make use of the PHN’s general practice support team to help you set up a system that works. • When you register a patient on My Health Record, enter the information slowly as if it’s entered too fast, the system will throw up errors. • When an error message occurs, click on the Refresh button and start over. • Bring up the topic during consults about care plans or health assessments. healthspeak August 2016



t was through involvement in the Integrated Care Collaboratives, run by North Coast Primary Health Network, that Graham and his staff met with Chris Barron, Nurse Unit Manager, Byron Shire Community Nursing, now based at the new Byron Central Hospital - about the mutual benefits of MyHR. “Chris was keen for us to consider MyHR as a better means of communication between the hospital and Bangalow Medical Centre. We decided that it would be helpful to get our significantly chronically ill patients onto MyHR, so that when they presented at Byron ED, the doctor on duty could access their past medical history and medications,” Graham told HealthSpeak. Graham works occasional shifts at the new Byron Central Hospital, and because the practice has now registered their sicker patients – those more likely to need a hospital stay - he is now able to talk Individually to doctors in ED to ensure that they start using MYHR. “Once these significantly ill patients are registered, it’s really all about trying to get other health professionals to know that the records are there and to make use of the information,” he said. At Bangalow Medical Centre, the system to encourage patients to register for a MyHR has become more streamlined. “For a couple of months, every time someone came in who looked like they might end up in hospital, we talked to them about feeding their information into MyHR and then it spread to each time someone came in for a health assessment and sometimes for a care plan as well.” The practice nurses generally look after updating the patients immunisation and alAugust 2016 healthspeak

WE TRY TO INVEST IN THE MEDICAL RECORDS AS MUCH AS WE CAN What Graham would like to see is more coordination with Community Health workers regarding MyHR. “At this stage it doesn’t appear to be part of Community health routine to send the GP a letter outlining the completion of a series of patient visits or a treatment episode form. I’d like to see these people making use of MyHR as well. “I’m not quite sure where the community health records end up, but at the moment we don’t see any of that in our practice.”. Graham would also like regular coordination meetings around MyHR set up in order to improve the flow of information and refine systems. “It would make sense to have six monthly coordination meetings between those people who have access to MyHR in some way - senior people in community health, in ED and specialist representatives. It would be useful to have ongoing ‘get togethers’ to keep people using the system in the best possible way,” he added.



North Coast Primary Network’s General Practice Support team is ready and willing to help practice staff register and use My Health Record. If you’d like a personal visit from one of our team, contact Tweed team on 07 5589 0500; Lismore team on 6627 3300; Mid North Coast team on 6659 1800 and the Hastings/Macleay team on 6583 3600.

ONLINE TRAINING Online training for the My Health Record system includes simulations on how to view and upload information to the My Health Record system using some common clinical information systems, as well as the My Health Record Provider Portal.


Dr Graham Truswell from Bangalow Medical Centre

lergy information and the process of patient consent for MyHRs. The practice also made use of their medical student to talk to patients about consent. “We’ve always spent a lot of time maintaining past medical history, results, discharges and specialists’ letters, so it isn’t too onerous to upload usually. Some doctors are better at it than others. It’s become one of the processes within the practice and we try to invest in the medical records as much as we can.” Graham said that patients have not had any privacy issues around MyHR, although some have requested that certain past medical history items be deleted. Graham has no concerns about discharge summaries from Emergency Departments – the practice is receiving them and the system is working well through Byron, Lismore and Tweed Hospitals. However, he is hoping that if one of his patients registered with MyHR goes to a Sydney hospital, then he’ll receive a discharge summary from there, something that hasn’t happened in the past.

Examples of the topics covered in the training are: • The types of clinical documents held in an individual’s My Health Record • Consent and how it relates to viewing and uploading of clinical information • Accessing an individual’s My Health Record in the event of an emergency • Ensuring quality data is uploaded to My Health Record. To access this training, visit myhealthrecord.e3learning. com.au.

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THE INTRODUCTION OF 'HEALTH CARE HOMES' N HEALTHDIRECT Healthdirect offers the following services


• National Health Services Directory: http://www. healthdirect.gov.au/ australian-health-services • Healthdirect nurse helpline: call 1800 022 222 • After Hours GP Helpline: call 1800 022 222 • Pregnancy, Birth & Baby: advice and support on 1800 882 436 • Mindhealthconnect website: http://www. mindhealthconnect.org.au/


• Palliative Care After Hours Helpline: Phone 1800 548 225 5pm to 9am, 7 days a week. • My Aged Care: information on care and local services on1800 200 422 • Carer Gateway: Help for carers, call 1800 422 737 Monday to Friday 8am to 6pm.


ext year there will be a staged rollout of a nationally supported Health Care Home model to provide Australians with improved co-ordination, management and support for chronic conditions. The Health Care Home (often referred to the ‘Medical Home’ or ‘Patient Centred Medical Home’) is a high quality and cost efficient approach to patient care. Health Care Homes will be rolled out from July 1, 2017 in seven trial regions based on Primary Health Network boundaries. Health Care Homes will be trialled in up to 200 general practices and Aboriginal Medical Services. This model will allow patients to nominate a GP practice as their ‘home base’, where they will have access to tailor care packages and simplified care management. Up to 65,000 Australians will participate in the two-year trial of Health Care Homes which is limited to Medicare-eligible patients with two or more complex or chronic conditions. The aim of a successful Health Care Home model is to keep patients healthy at home and out of hospital by providing continuity of care, coordinated services and a team approach based on the needs of the patient. My Health Record will be an essential element of the Health Care Home trial.

NEW HEALTH DIRECT PRODUCTS Heath Direct continues to manage and strengthen the GP After Hours Helpline. As you may know, the free Helpline service provides access to a GP over the phone, and operates at night from 6pm to 8am, as well as weekends and public holidays. Practices should also be aware that the Helpline will refer patients, when a face to face consult is required, to local general practices which are open by using the National Health Service Directory (NHSD). Therefore, simply ensuring your practice details are up to date can bring in new business. Knowing this may support your decision to consider extending your practice hours by opening earlier, closing later or introducing new Saturday or Sunday hours. The NHSD is a national register of allied health services which provides consumers

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with easy access to reliable health services information. This includes medical clinic contact details, location, opening hours, wheel chair access and bulkbilling services. To check your NHSD listing. go to http:// www.nhsd.com.au/ If you aren’t already listed in the Directory, register at: www. healthdirect.gov.au/nhsd-registration If your service is currently listed but the information is incorrect or incomplete please email updates to nhsd@healthdirect.org.au Your Primary Health Network General Practice Support Team can assist you to add your service information to the NHSD if required. Once registered, consider diarising a staff member to update details every month or so to ensure your practice information is accurate. Health Direct also has funding from the state and federal governments to provide a number of other health information services for the consumer. The 24 hour Palliative Care Helpline

Supports people who receive palliative care, their carers, parents and families, particularly when other medical care is not available after hours. They provide advice and support for pain management, medication information, equipment (eg syringe pump) and basic counselling support. The hotline number is 1800 548225. http://www.healthdirect.gov. au/the-palliative-care-after-hours-helplinensw-only Pregnancy, Birth and Baby (PBB)

A support and information service for expecting parents and parents of children aged 0-5 years. It provides trusted information from healthcare professionals. The service is available seven days per week and the number is 1800 882 436 or via a video call www. pregnancybirthbaby.org.au Over the coming weeks your General Practice Support Officer will be mentioning these services as well as offering a range of promotional material for the use of your patients. If you require more information or resources immediately, contact Diana Anderson, Senior Program Coordinator – After Hours on 0409 249 728 or danderson@ ncphn.org.au

healthspeak August 2016

The vital role of mental health nurses: Ochre GP Superclinic, Grafton


t’s a Tuesday morning and the waiting room is bustling with patients. HealthSpeak has been invited to meet the clinic’s two credentialed mental health nurses, Scott Hanson and Bronwyn Gibson. Practice Manager Carol Pachos explains the need for these specialist nurses. “Because we have so many GPs here, there’s a flow on effect with allied health, we could have another full time mental health nurse here,” she said. Doctors at the SuperClinic refer patients to the nurses and numbers are growing with Scott and Bronwyn having 160 patients on their books. Both nurses are flexible and never knock back a patient desperate to see someone. Scott and Bronwyn are permitted 500 consultations each per year under the mental health care plan and Scott also sees clients under North Coast Primary Health Network’s Healthy Minds program. They also use Extended Primary Care plans. Bronwyn is warm and bubbly with a quirky sense of humour that puts people at ease. She’s always had a passion for mental health. For nine years Bronwyn’s worked as a mental health nurse and came to Ochre after colleague Scott, with whom she’d worked before, encouraged her to get credentialed. “I did my Masters, a prerequisite, and Scott was hounding me when I was working out the back of Broken Hill to get the paper work done to become credentialed,” she said. Bronwyn has now been working in Grafton for two years. “We provide counselling and support for patients, help them with paperwork, whatever they require. Mental health isn’t just August 2016 healthspeak

what’s going on inside your head, it’s also your external environment. It could be looking for housing which around here is difficult, financial struggles, limited work opportunities. Helping them this way relieves some of their anxiety or depression, they know there’s someone to support them,” she explained. Both nurses have a four week waiting list and manage clients with a range of conditions. The clinic has also set up a free Healthy Lifestyle group on Fridays where clients are invited to come in and do some craft work together. “Scott’s trying to get a men’s group up and going too and I also do a women’s group - Sassy Sadie’s Sewing, we call it to make people feel a bit better.

You don’t realise how isolated some people are. Here they listen to each other might exchange numbers to connect over coffee “A lot of people with anxiety can’t go out in public, so they come to the group, share food and sit around talking. You don’t realise how isolated some of these people are. Here they listen to each other might exchange numbers to connect over coffee.” Scott’s been working at the SuperClinic for four and a half years. He discusses clients with the doctors to work out the most suitable program. Clients with anxiety and depression make up three-quarters of cases.

Practice Manager Carol Pachos and nurse Bronwyn Gibson with some of the artwork created by clients in their Healthy Lifestyles group.

“There are a lot of personality issues involved and I’d say clients with comorbidities as far as alcohol and cannabis and ice are concerned would run at around 75%,” said Scott. He is understandably proud that despite the caseload he and Bronwyn manage, over four years they’ve only had a tenth of one per cent of clients who’ve ended up in hospital, a brilliant outcome. Scott would love to see the clinic employ at least one more mental health nurse. He’d also like to see university programs encourage nurses to consider going into mental health while they are training. As I leave the SuperClinic, Carol tells me a story that sums up the compassionate approach the clinic extends to its patients. “A couple of weeks ago a grandma came in with a 14-year-old boy experiencing mental health issues – he’d been using cannabis since he was 11. They’d been up to the hospital and he’d been dis-

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charged without seeing anyone from the mental health team. She said ‘I think this is his last day on the planet’. She was at her wit’s end and he was not even our patient. So I took the grandma and the boy out into our courtyard. Bronwyn came out and had a chat and took the boy in with her and started to connect with him. He’s now in our program and has the support he needs.” View past issues

Did you know you can read HealthSpeak online? Go to www.issuu.com/ healthspeak and see all 16 issues.


Koori Grapevine Visit to low vision clinic


CPHN’s Closing the Gap program officer in Coffs Harbour Helen Lambert has coordinated regular Wellness Days, providing health information for the Elders of Jagun Aged Care. Recently, a Guide Dogs NSW/ ACT team from Coffs Harbour has collaborated with NCPHN, resulting in a group booking for Jagun Elders at the Low Vision Clinic at Eyecare Plus in Nambucca Heads. Blindness rates in Aboriginal and Torres Strait Islander people are six times higher than those found in other Australians. Around 94 per cent of vision loss is unnecessary and much of it can be resolved overnight, yet 35 per cent of Indigenous Australians have never had an eye examination. The leading causes of blindness and vision impairment are: cataract, diabetic retinopathy, refractive error and trachoma. The Elders had their vision tested and lifestyle issues relating to their vision will be addressed by Guide Dogs NSW/ ACT Orientation and Mobility Instructors. Where required, appropriate Low Vision Aids were issued to clients to improve their quality of life, and follow up plans put in place to ensure the clients’ ongoing needs are met. Seven elders had vision and eye health tests with three clients requiring new glasses. Two clients were referred to an ophthalmologist and assistance was provided through NCPHN’s Care Coordination and Supplementary Services program to cover the cost of consultation and transport to and from the appointment. 20

Guide Dogs NSW/ACT Jeremy Hill & Lyndel Bosman, with NCPHN’s Helen Lambert (centre)with the staff and Elders from Jagun Aged Care.

Elders show their appreciation

Pictured from left: Aunty Laura, Ken, Sue, Bev, Rhonda, Bill, Aunty Vi, Maria, Aunty Loretta, Les and Muriel.


boriginal Elders of Bowraville and the Nambucca Valley have produced a stunning triptych painting and presented it to North Coast Primary Health Network in appreciation of the Wellness Days the Network helped to instigate. The painting tells a story of “the gathering of learning, to balance wellness within the community”. NCPHN’s Indigenous Health Program Officer Helen Lambert said staff were very honoured to be given the painting. “It’s an honour for us to work with the Ngambaga Bindarry Community Services (NGBCS) Elders to improve their health

outcomes. The painting will hang in a prominent place in our office for everyone to enjoy,” she said. The painting was completed at an art and craft day run to celebrate the success of the Wellness Days, which have been running now for 18 months. A year and a half ago, Helen Lambert met with Rachael Gillin of NGBCS to develop the idea of health information days (Wellness Days) for Elders at the service and those living in Bowraville and the Nambucca Valley. NBGCS provides support services to Aboriginal people who are elderly, frail aged, living with a disability or act as a carer.

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The Elders embraced the idea and named the events Girrwaa (Gumbaynggirr for big mob) Wellness Days. Such gatherings are important for this community which is a remote area and lacks public transport, an ambulance station, hospital or taxis. At each monthly Girrwaa Wellness Day, health professionals provide information on a particular health topic such as diabetes, foot care, dementia, nutrition etc. The information is delivered in an informal way to ensure a culturally safe space exists, which in turn promotes active interaction and participation. Helen Lambert said that the Wellness Day events provide an opportunity for yarning, discussing health issues, making them personally relevant and taking away learnings “The Wellness Days contribute to the social and emotional wellbeing of the group. In addition, the yarning circle allows the group to support and encourage one another. By increasing the health literacy of the group, participants can keep one another on track for a healthier lifestyle,” she said. healthspeak August 2016

NNSWLHD commits to bigger Aboriginal workforce


orthern NSW Local Health District (NNSWLHD) has made a commitment to a more diverse workforce by embracing NSW Health’s Stepping Up campaign. Stepping Up is a website that helps Aboriginal people find jobs in the health sector. NNSW LHD Chief Executive Wayne Jones said Stepping Up assisted employers in finding Aboriginal candidates for positions across the health sector. “Stepping Up provides information and tools to help managers find the best person for each position,” Mr Jones said. “It’s important we place people in jobs that match their skills, experience and aspirations so they’re more likely to stay in the health workforce and carve a meaningful and successful career. “NNSW LHD is committed to increasing Aboriginal representation in our health workforce and it’s very encouraging to see such a high number of hits on the Stepping Up website.” The website highlights a range of employment opportunities including medical and primary care practitioners, nurses, midwives, service and program managers, Aboriginal Health Workers, Aboriginal Mental Health Workers,

Wayne Jones

administrators and leadership positions. The Stepping Up website provides: • Guidelines on employing and supporting Aboriginal staff • Information on cadetships and scholarships • Help with searching for a job • Information about available positions • Job application tips • Information about submitting a job application • Details on screening and checks. The Stepping Up website can be viewed at: www.steppingup. health.nsw.gov.au

Aboriginal mothers: much greater risk of preventable death


study by researchers at the Telethon Kids Institute has found Aboriginal mothers are at a significantly greater risk of preventable death than other Australian mothers. The study, published in BMC Public Health, found Aboriginal mothers were much more likely to die from external causes, such as accidents, suicides and homicides, and usually left more and younger children. Telethon Kids Institute researcher Dr Carrington Shepherd said the loss of a mother can have a deep-rooted impact August 2016 healthspeak

on families and the team’s study highlighted the need for more to be done to protect this at-risk group from premature death. “Maternal loss can have a particularly traumatic impact on children and their development,” Dr Shepherd said. “This can include prolonged periods of grief, depression, stress, anxiety, problems with identity development, the difficulties associated with the transition to out-of-home care, and the onward elevated risks of substance abuse and suicide in later life.”

Bulgarr Ngaru wins Kidney Health Award

Staff receiving their award on Reconciliation Day


n late May, Kidney Health Australia’s Indigenous Project Officer Michael Mullins travelled to Casino to present Bulgarr Ngaru Aboriginal Medical Corporation with an Award of Excellence for service in addressing Chronic Kidney Disease in the region. While there Michael met with the Casino AMS Chief Executive Officer Steve Blunden and key staff members to discuss possible opportunities that may arise in the near future. The Official presentation of the Award was made to coincide with the Reconciliation Day Celebration where Michael presented the Award to the Chronic Disease Coordinator Kylie Wyndham

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and clinical staff renal nurse practitioner Graeme Turner and Debbie Caldwell. Michael acknowledged their tremendous work in addressing Chronic Kidney Disease and expressed hopes that Kidney Health Australia can look forward to working more closely together in the future. Bulgarr Ngaru’s award was one of the new Primary Care Awards given out by Kidney Health Australia. The Awards were adjudicated through Kidney Health Australia’s Primary Care Education Committee, comprising prominent kidney specialists, health professionals and educators. Congratulations to Bulgarr Ngaru for their great work in the field of chronic disease.


Transfusions spread HIV in India

Anti-viral condoms for athletes



t least 2,234 Indians have contracted HIV while receiving blood transfusions in hospitals over the past 17 months. The information was revealed by the country's National Aids Control Organisation in response to a petition filed by information activist Chetan Kothari. Mr Khothari told the BBC that he was "shocked" by the revelation. India has more than two million people living with HIV/ Aids. The highest number of patients who had been infected with HIV as a result of contaminated blood in hospitals, were

from the northern state of Uttar Pradesh with 361 cases, Mr Kothari's query revealed. The Indian capital Delhi is at number four with 264 cases. Under law, it is mandatory for hospitals to screen donors and the donated blood for HIV, hepatitis B and C, malaria and other infections. "But each such test costs $US18 and most hospitals in India do not have the testing facilities. Even in a big city like Mumbai, only three private hospitals have HIV testing facilities. Even the largest government hospitals do not have the technology to screen blood for HIV," Mr Kothari said.

his month, Australia will compete at the Olympics in Rio de Janeiro, and will supply them with condoms and antiviral lubricant that provide more protection than regular condoms. The condoms and lubricant will help protect against sexually transmitted diseases including HIV, genital herpes, and human papillomaviruses. They might also protect against the Zika virus.

The condoms help prevent infection through a combination of defences. The first layer of is the the condom itself. The second layer of protection is the lubricant, called VivaGel.The condoms are only antiviral when used with the lubricant. The VivaGel lubricant also potentially provides added protection against HPV which is a causative agent in the development of cervical cancer.

Third symposium a great success! By Professor Iain Graham Dean, School of Health and Human Sciences Southern Cross University


n May, the third annual Nursing and Midwifery symposium organised by the School of Health and Human Sciences, at SCU, in partnership with the Nursing and Midwifery Directorate of the NNSWLHD took place. The reviews were most positive and the event is maturing nicely. The title was, ‘ Celebrating the Diversity of Nursing and Midwifery Practice’. Acting CNMO, Anne Robertson presented the key address. The papers presented by the region’s nurses and midwives went under four themes – Research Activity and its impact on nursing actions; Patient Centred Care; Employment/ Work relationships and Technology; and Self-Care Skills and Knowledge. Ms Robertson provided some interesting insights into how nurses and midwives are


responding to the impact of health system change. The needs of an ageing population, technological developments, advances in self-care and chronic health care management all require a strong nursing voice and role she told delegates - and one which this region’s nurses and midwives were responding to. The first theme demonstrated the importance of nurses’ involvement in research to expand evidence-based care structured around quality indicators. The papers presented also suggested that research helps nurses to find their voice and ensure their contributions to care are warranted and purposeful. The second theme’s papers raised issues around systems, processes and evaluating care provision. The need for such systematic approaches to care is due to the fact that the complexities of human nature and the experiences of patients throughout their health and wellbeing journey require a

sophistication not considered when organised health care was first devised. The importance today of matching resources to patient need is crucial and these papers spoke about the need for nurses to understand workflow, care delivery and the required interventions in order to provide a more patient centred approach to care. This requires a synthesis of both the art and science of nursing in order that the actions of review- plan-actreview-change can be achieved. The third theme’s papers included discussion about the fact that nursing requires that nurses themselves listen to each other about care provision more honestly and reflectively. Nursing is a 24/7 business built around team work and requiring on- going educational development and execution. Patient care defines the role of the nurse or midwife. The patient’s story should inform them as to what work is required, but the need

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to continually ensure one’s competence and capability as a practitioner was central to this theme. The last theme focused on the concept of professional accountability and responsibility. Assuming responsibility allows one to be held accountable and thereby be granted a degree of autonomy for one’s practice. These papers raised the need for nurses to know what was required of them by patients and from others if this was to be achieved. The demands on our evolving health and social care systems will require a reappraisal of many current practices and activities. I look forward to the offerings at next year’s Symposium.

healthspeak August 2016

Ensuring children are ready to learn in Tabulam


s a joint initiative between Bulgarr Ngaru Medical Aboriginal Corporation – Richmond Valley, Northern NSW LHD, North Coast Primary Health Network and The Royal Far West, child health check days have been held at Tabulam Primary School in May and July this year; and at Tabulam pre-school in March. The child health days aim to improve the health and wellbeing of all children involved, through the identification of health issues, the early detection of risk factors and the promotion of healthy lifestyles. At Tabulam Primary School, all students from Year K to 6 completed a comprehensive child health check which included growth, vision, hearing, oral health, nutrition, developmental and medical screening. In addition, students from Year K to 3 had a speech and language assessment. Hearing assessments were performed on the Royal Far West Healthy Kids bus which was at all screening

Kinship Day: promoting healthy living

I Staff from the various organisations that partnered to hold the Child Health Check Day in Tabulam.

days to complement the services provided. All families received feedback after the screening and follow up appointments with clinicians were recommended if needed. Joan Clay, Child and Family nurse at Bulgarr Ngaru – Richmond Valley said that it was great to watch the children go through the various health stations and interact with each of the staff. “At the end of the day we all get together and have a case

conference to plan forward for the children’s health as required,” she said. Claire Malseed, Aboriginal Maternal and Child Health Program Officer at NCPHN said that schools were an ideal setting to conduct these multidisciplinary health checks. “It is important that health and education staff are working together to ensure that children have no health issues affecting their ability to learn at school.”

Ticks: potential for anaphylaxis


esearchers have reported the first confirmed cases of tick-induced anaphylaxis in the world and they are in NSW and Queensland. They came about during attempts to remove ticks rather than killing them while under the skin. Published in the Journal of Allergy Clinical Immunology Practice online July 6, the researchers from the Australian Venom Research Unit in Melbourne and Watkins Medical Centre in Brisbane said that usually tick-related deaths are linked to paralysis from tick toxins. To find the cases, the researchers combed coronial and hospital mortality reports identifying four cases attributed to anaphylaxis following bites between 1979 and 2013. August 2016 healthspeak

One death occurred in a man with a severe allergy history to ticks and bees – he lost consciousness after removing a tick from his neck. Despite the administration of adrenaline, the man died the following day. The researchers can’t be certain whether the device failed or it was a case of epinephrine-resistant anaphylaxis. The other cases involved a man with a history of pneumo-

thorax and mild asthma who collapsed after a tick was dislodged from his scalp; another who died within an hour of a tick being taken out of his hand; and a woman with a history of tick bite allergy and asthma who was found to have a tick on her scalp during a post mortem examination. In a research letter, the authors said the cases were most likely attributable to I holocyclus [the paralysis tick] and represent the first documented fatalities from tick bite-related anaphylaxis. They added that ‘given the lack of recent fatal tick paralysis cases, tick-induced anaphylaxis seems as important, if not potentially more significant than tick toxicity.’

a publication of North Coast Primary Health Network

n May, members of the Northern Rivers and Tweed Aboriginal Health teams represented North Coast Primary Health Network at the Murwillumbah Kinship Festival, to celebrate Aboriginal kinship, culture, and connection during National Families Week. The festival opened with a traditional smoking ceremony and corroboree. Other features included local musical performers, a free bush tucker lunch, arts and craft workshops, and elders sharing stories and wisdom. In addition to providing resources and guidance regarding the services offered through the NCPHN, the team enjoyed the chance to talk with the community about making positive health choices, particularly in relation to food. Aboriginal Health Project Officer Ruth Taylor commented: “We see nutrition as being absolutely foundational when it comes to the Closing the Gap initiative, and while education regarding food choices is only one element, because other barriers to good nutrition are also significant, these events provide the perfect platform for education, and so we want to take advantage of that!”


Changes to Children Protection Act


hapter 16A is a chapter of the NSW Children and Young Persons (Care and Protection) Act relating to information exchange. Its objective is to help provide services to children or young people by authorising and requiring the sharing of information between ‘prescribed bodies’ in a collaborative fashion. Information that relates to the safety, welfare or wellbeing of a child can be exchanged without client consent and takes precedence over other laws. Since the enactment of the Act, the following are prescribed bodies: • the NSW Police Force; • a NSW government department or public authority, including the Department of Family and Community Services, Community Services; • a NSW government school or a registered non-government school; • a NSW TAFE; • a NSW public health organisation or a licensed private

health facility; • a FACS-accredited or FACS–registered out-ofhome care agency; • a FACS-accredited adoption service; • the Family Court of Australia, the Federal Magistrate’s Court of Australia, Commonwealth • Department of Human Services and the Commonwealth Department of Immigration & Multicultural & Indigenous Affairs; and

• any other organisation which has direct responsibility for, or direct supervision of, healthcare, welfare, education, children’s services, residential services, or law enforcement, wholly or partly to children. The Regulation brings the following private health practitioners into the requirements of the Care Act, regardless of whether they work for an organisation or not: • nurses • registered medical practitioners • registered midwives • registered psychologists • persons registered under the Health Practitioner Regulation National Law to practise as occupational therapists (other than as students), • speech pathologists eligible for membership of Speech Pathology Australia. The Regulation also extends alternative reporting arrangements to the Health Child Wellbeing

Unit under section 27A of the Care Act to all registered medical practitioners and general practice nurses (NB not all groups above). This will enable these health professionals to report child protection concerns to the NSW Health Child Wellbeing Unit as an alternative to the Child Protection Helpline thus fulfilling their obligations as mandatory reporters under the Care Act. The contact number for the Child Wellbeing Unit is 1300 480 420.

This information can be found on the HealthPathways website at : https://manc.healthpathways. org.au/88091.htm Username: manchealth Password: conn3ct3d

For further information contact: Anne Norman, Child Wellbeing Coordinator (Mid North Coast Local Health District) anne. norman@ncahs.health.nsw.gov.au Nicole Ashby, Child Wellbeing Coordinator (Northern NSW Local Health District) nicole.ashby@ ncahs.health.nsw.gov.au

It’s a hearing hat trick


ike many Aboriginal and Torres Strait Islander Australians, Bundjalung man Joshua Fares, and his 15-yearold-son William, both experienced middle ear infections throughout childhood, which has led to them developing hearing loss. The good news for William is that he is the recipient of a ‘hearing hat’, a first for the Clarence Valley region, but an innovation that families in remote communities would be familiar with through Australian Hearing. “On a recent visit to Bulgarr Ngaru for his hearing check, the audiologists from Australian Hearing told us about a hearing aid that goes into a


hat,” explained Joshua. “We only needed to pay for the hat William wanted which was $20. The hearing aid was supplied by Australian Hearing.” The hearing hat has a bone conduction hearing aid tucked securely inside. Microphone tubing pokes through a hole on top of the hat to pick up speech sounds. It is a clever option for young people like William who might feel more comfortable in a hat than wearing a hearing device on its own. “The hat makes it easier to wear hearing aids as I don’t feel like it stands out so much,” said William. “I got to pick the style and it’s just right for me!”

William and Joshua with the hearing hat in Grafton.

William, his parents and teachers all agree the hearing hat has brought improvements to his schooling including having the confidence to ask and answer questions, while feeling happier overall. Australian Hearing provides government-funded hearing

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services and hearing devices for eligible Aboriginal and Torres Strait Islander children and adults. To contact the nearest Australian Hearing Centre call 131 797 or visit www.hearing. com.au

healthspeak August 2016

Easier referral pathway for aged care ups,” said Sue. Here’s a summary from the fact sheet about how to make referrals: How do GPs make referrals? To refer a patient on to My Aged Care for an assessment, it is preferred that GPs use either of two methods: • Use the online health professional referral form that be accessed via the ‘Contact Us’ page on the My Aged Care website or via MyAgedCare.gov.au/ referral; or • Call the My Aged Care contact centre on 1800 200 422. Note that referrals can also be faxed to the My Aged Care contact centre, however be aware that if a referral is made via fax (1800 728 174), the contact centre will be unable to acknowledge receipt of the


Ps will know that over the last 12 months there have been a lot of changes to the My Aged Care website and how to refer older patients for assessments. These changes, while improving the process, have created a lot of confusion among health professionals. Sue McGuigan, RAS Manager, Northern NSW Aged Care Assessment Team (ACAT) told HealthSpeak that a new fact sheet and webform will make things a great deal easier and smoother for both doctor and patient. The new fact sheet will also, hopefully, clear up any confusion. “By using the new webform, which recognises GPs as a trusted referral source, GPs can bypass the contact centre staff, where assessment referrals can go astray, and have their referral sent directly to ACAT staff. There is also a tracking system with an ID number for follow

referral. When the online referral form is used referrers will receive confirmation that their referral has been received as well as a unique reference number so they can follow up the referral if necessary. Further benefits include faster processing and the ability to print and save the web form

as a Portable Document Format (PDF). The fact sheet including information on the webform can be found at: https://agedcare.health.gov. au/programs/my-aged-care/ general-practitioner-fact-sheetjune-2016-update

Promoting Healthy Living


ost people do not look forward to the day when they move from their own home to an aged care facility to get the support and health care they need. Feros Care, with three villages in the Northern Rivers, is working to make the transition to residential aged care a positive one. Pets are welcome and another way to help residents connect is through Feros Care’s use of technology. Using video conferencing, Feros has partnered with Bay Medical – a general practice in Byron Bay - to meet the needs of seniors living in residential care with complex conditions. Over the past two years, Bay Medical has conducted more than 400 video calls with Feros Care Village in Byron Bay involving four GPs and 48 seniors. This video access has August 2016 healthspeak

Feros resident Maggie in a video conference session with her GP

meant that 52 hospital admissions have been avoided, and the transport cost for seniors reduced by a massive $40,000. In addition, care has been able to be provided in after hours situations without the resident having to leave the facility. A weekly virtual clinic has

been operating for 18 months. The video call replaces faxes and phone calls with a more meaningful connection for both seniors and general practitioners. The use of video conferencing in this way has resulted in this project between Feros Care

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and Bay Medical becoming a finalist in both the inaugural North Coast Primary Health Care Excellence Awards and the 2016 HESTIA Aged Care awards. Helping seniors embrace technology to improve their wellbeing is another aim for Feros Care. Wheel.I.Am, a telepresence robot, beams vision of art gallery tours, surf checks, and local street life back to residents in villages who would otherwise be unable to experience these things. Similar technology enabled Alma to attend her grandson’s wedding in the UK virtually from Feros Care’s Wommin Bay village. According to Alma, she had the best seat in the house. “The wedding was so far away but was right there, on my tele. It was so special, not just for me, but for my grandson too” she said. 25

Aged Care Update



Symposium put spotlight on dementia


Aged Care Update

two-day Aged Care Symposium being held in Ballina in late July focused on the theme The Forgotten Issues of Dementia - Emerging Insights and Developments. The Symposium was a collaborative event hosted by the Northern NSW Local Health District and North Coast Primary Health Network. More than a dozen guest presenters took the stand over the two days covering a range of topics from caring for someone with a cognitive impairment to the delicate topic of sexuality and dementia. The guest line up provided

Kate Swaffer

a broad understanding of the challenges faced by people living with dementia. Two workshops were held at this sold out event concurrently looking

at the experience of dementia as well as how to build memory bridges and establish care competency goals with dementia. The day that HealthSpeak attended, the Symposium had three fascinating speakers – former nurse Kate Swaffer who has written a book on her personal experience off onset dementia; Professor Wendy Moyle talking about the use of robots, such as harp seal lookalike Paro in residential aged care and psychiatrist Dr Graeme Halliday who brought the audience up to date on severe domestic squalor and the mental states of those living in such conditions.

Relevant HealthPathways topics HealthPathways has a number of pathways relating to older patients. Go to https://manc. healthpathways.org.au (username: manchealth; password conn3ct3d) and clock on older person’s health on the menu tab at the left. Pathway topics in this section include Cognitive Impairment & Dementia; Elder Abuse & Neglect, Falls Prevention; Depression in Older Persons; Navigating Services for Older Persons and Before Entering Residential Aged Care.

Most common hospitalisation for dialysis


uring 2014/15 there were over 10 million hospitalisations overall, with the most common reason being dialysis for kidney disease (1.4 million hospitalisations), followed by cancer (1.1 million). This information is contained in an Australian Institute of

Health & Welfare report released in late July. About one in four hospitalisations involved surgery, with 60% of surgery occurring in private hospitals. Cataract extractions were the most common surgeries performed (246,000). Public hospitals admitted

Free program to reduce alcohol use


SW Health has launched a free alcohol reduction program to help people improve their health by reducing their alcohol consumption. The program, The Get Healthy Service, consists of 10 coaching calls, coupled with alcohol-related education, management and goalsetting strategies. Participants can set a weight, healthy eating, physical activity or alcohol reduction related goal. Designed for people aged 18 and over, the program is aimed at people wanting to reduce their alcohol consumption to reduce risk fac-


tors for chronic disease and achieve a healthier lifestyle. All participants will be screened for their alcohol risk at the time of enrolment using the Alcohol Use Disorders Identification Test (AUDIT). To ensure safe clinical practice, people who are drinking harmful levels of alcohol will be referred to appropriate specialist services such as the Alcohol and Drug Information Service. To register a patient or for more information visit the Get Healthy Service website www.gethealthynsw.com.au or telephone 1300 806 258.

about 700,000 patients from elective surgery waiting lists, with 50% admitted within 35 days of being placed on the waiting list. For the first time, outpatient clinic data were provided for all public hospitals that provide these services. Around 34.9 million outpa-

tient services were reported. About 46% of outpatient service events occurred in allied health and/or clinical nurse specialist clinics. Thirty per cent occurred in medical consultation clinics, 13% in procedural clinics and 10% in stand-alone diagnostic clinics.

Updated COPD Resources


ollowing the latest revision of the COPD-X Guidelines, Lung Foundation Australia has updated the corresponding resources including the COPD-X Concise Guide – a useful summary of the COPD-X Guidelines available online as a fully searchable PDF with practice tips to aid clinical care. Other valuable resources updated include the Stepwise Management of Stable COPD, COPD Action Plan and the COPD Medicine Wall Chart. All the resources now include the latest pharmacotherapies which were updated in the COPD-X Guidelines after a review of the published evidence up to December 2015. Download resources here:

a publication of North Coast Primary Health Network

The Stepwise Management of COPD http://lungfoundation.com.au/ health-professionals/guidelines/ copd/stepwise-managementof-stable-copd/

COPD Action Plan http://lungfoundation.com.au/ health-professionals/clinicalresources/copd/copd-actionplan/

COPD Concise Care Guide http://copdx.org.au/wpcontent/uploads/2016/03/ LFA-COPD-X-Concise-Guide_ V3.02_0316_web.pdf

COPD Medicines Wall Chart http://lungfoundation.com.au/ wp-content/uploads/2014/02/ COPD-Medicines-Wall-Chart_ A4.pdf healthspeak August 2016

What is health literacy?

Health Literacy Northern NSW

Health literacy is important because it affects how well you can:

Health Literacy is a priority to improve the health of people in Northern NSW Health Literacy means how well people can access, understand and act on health information and services. It also means how easy health systems are for people to navigate, and how health professionals communicate with patients and carers.

Find the right services and doctors

Manage your own chronic health conditions

Show up at appointments

Take medicine the right way

Fill out health forms

Tell doctors about your medical history


Look after your own health

Health Literacy eLibrary

Understand how risky behaviours affect health


Consumer/ Health carers Professionals Ambassador Literacy Program (CAP) Champions


Follow advice about how to stay healthy

Health System Policy

Patients as Partners in their own care



of Australian adults do not have the level of health literacy needed to meet the complex demands of day to day life.

patient quality of life patient satisfaction patient care experience

Healthier people in Northern NSW NNSWHealthPromotion@ncahs.health.nsw.gov.au

What is? What is Feldenkrais?

Profile Janet Auret – Feldenkrais Practitioner, Clunes

F Moshe Feldenkrais in a training session

The aim is a body that is organised to move with minimum effort and maximum efficiency, not through muscular strength but increased consciousness of how it works.” Moshe Feldenkrais, D.Sc.


he Feldenkrais Method facilitates learning through lessons that explore movement, posture and breathing, resulting in mproved ability in all aspects of life. The Feldenkrais Method is tailored to meet an individual’s needs and interests and is beneficial in a variety of applications - from childhood development to older adults, sport and performance to chronic conditions, injury prevention to rehabilitation. People of all ages can participate, from babies and children through to senior citizens, with interests ranging from dancing, music and athletics to people seeking to relieve movement difficulties, stiffness or pain, or simply to learn a new way. The Feldenkrais Method uses the brain’s ability to change in response to specific sensory input. This neuroplasticity is central to the Method’s effectiveness. Participating in this learning process can lead to better 28

health and well-being, improved attention, thinking, emotional resilience, posture, coordination and balance, easier ways of doing tasks, easier breathing, reduced pain and control over muscular tension. The Feldenkrais Method is delivered in two ways: Classes called Awareness Through Movement® - a Feldenkrais practitioner guides participants through a planned sequence of movement explorations. Individual lessons called Functional Integration® - The lessons are tailored to each client’s needs. The practitioner guides movements through precise touch. The client lies or sits, comfortably clothed, on a low padded table. The practitioner brings present habits into focus and offers new movement options. The learning is then applied to activities such as reaching, sitting, standing and walking. To locate a practitioner go to: www.feldenkrais.org.au/ directory/practitioner/search/ results To find out more, go to: www. feldenkrais.org.au/practisingfeldenkrais/health-professionals

or many years, Northern Rivers Feldenkrais practitioner Janet Auret felt silenced. “Because Feldenkrais is an experiential method it is so outside of the medical paradigm. I felt silenced when talking to physiotherapist colleagues or medical professionals because the way in which I look at someone’s movement is different and the language is different. “There were no randomised controlled trials and what is referred to as ‘evidence based’ research, although Feldenkrais would argue that he worked from the evidence before him. In fact, the Feldenkrais method does not fit with randomised controlled trials because it is so responsive to each situation. However, research in recent years on neuroplasticity has given Feldenkrais practitioners voice.” It was a great relief to Janet when this research came out, validating the Feldenkrais Method and proving that the brain is a plastic, living organ that can change its structure and function, even into old age. A boost towards wider acceptance came when psychiatrist Norman Doidge included a section on the benefits of Feldenkrais in his book The Brain’s Way of Healing. In his first book The Brain that Changes Itself, Dr Doidge told stories of stroke patients recovering their faculties,

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children with cerebral palsy learning to move more gracefully, entrenched depression and anxiety disappearing, and lifelong character traits altered. “With Feldenkrais we would say ‘You can do this movement one way, let’s find two more options. Our system has almost infinite possibilities,” Janet said. Pain and dysfunction can be relieved by widening our options. Janet has been in the Northern Rivers since the early ‘80s and has worked mostly in rehab, an area of complex injury and neurological difficulties, including people with strokes and acquired brain injuries. “I was a physio for 10 years before I came across Feldenkrais, and working in inpatient rehab I became frustrated at the limitations of working as a physiotherapist”’ While Janet’s physio training in Melbourne had been eclectic, offering a range of techniques, she soon came to see that a lot of what she’d been taught was not what she saw in the clinical setting. “One of the things said was that the most recovery you get from any brain injury is in the first six weeks, and after six months no further recovery is possible. Yet two years out as a physio I had a job in a big rehab complex and one man came in, a very quiet man who’d had a stroke four years previously. He said to me ‘Janet, my fingers have started moving’ and for four years

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they hadn’t moved at all.” After seeing this recovery and witnessing that some people after a stroke were not up to doing rehab in the first weeks at all, Janet realised there were no rules to follow and all sorts of things could be tried. However, she still felt frustrated that she couldn’t do more. It was around this time that, during a dance rehearsal, Janet witnessed a friend doing movements that fascinated her – they were based on the Feldenkrais Method. “They were more organic, much more about easy movement in space, not so much dance form as based on normal movement, and I thought ‘ooh, that’s interesting.’” A Feldenkrais practitioner since 1991, Janet works from home at Clunes with people from infancy up. Her practice is predominantly based on individual sessions but she also conducts weekly Awareness through Movement classes. For Janet, the great satisfaction of being a Feldenkrais practitioner comes from the pleasure of helping people to find new movement possibilities in themselves. So how does the Feldenkrais Method impact on a person’s life when they have restricted movement or pain?

“What matters is what’s important to that person, how they want to live their life, so I’m looking to marry what their interests are with what we can do to help them get towards that. “In the individual sessions people come to me for all sorts of reasons, sometimes they’d like to be better as musicians or performers, they’d like to do a movement more easily or they have a glitch in something they’re trying to do. Sometimes it’s because they are starting to get pain and they can’t perform as much or as easily as they used to. “Others come because they are unable to move well post-operatively. They say ‘I’ve broken my leg, I can’t walk properly anymore, it’s all healed but I can’t do what I used to do’. Neurological work – children with cerebral palsy and people who’ve had strokes are big interests of mine.” Janet harks back to her frustration with terminology when trying to explain Feldenkrais to medical colleagues. “For example the word ‘function’ has a very different meaning in Feldenkrais. Colleagues talk about getting someone to walk as a functional activity and I said ‘This is fine as long as it is comfortable for them, but if it is

not then we have to teach them how to walk, so that it becomes a pleasurable thing for them to do. It’s about the peeling back of movement to the level where you are not stuck in the habit and you can do it in a different way.” Janet describes working within a Feldenkrais framework as moving towards improving people’s lives. “That may sound grandiose, but most of us just want to reach our best potential and that can be very different from someone else’s. There’s no one size fits all, no recipes in Feldenkrais, other than that you are working all the time with the neuroplasticity, our capacity to learn experientially. “So I often will start working with what’s easy for someone rather than going to the “problem”. I want them to understand what it is to feel that things aren’t difficult. When movement feels easy then we will happily adopt it’ our system will go ‘yes thank you’, I’m using less effort I have more energy for other things, why not?” Janet also loves the fact that Feldenkrais is gentle work and she doesn’t have to use any technique that causes pain. “People get to learn to move and feel better about themselves. And with the children,

particularly those who’ve been born with a brain injury (cerebral palsy), giving them ways, giving them pieces of the puzzle that they couldn’t get to themselves so that they can move through space, so that they can problem solve, so they figure it out, that is the greatest pleasure.” So, in summary what does Feldenkrais offer? “Provided someone is willing to learn, it offers ways around situations, ways through. You are learning to move differently and that opens up a wealth of possibilities. For instance, if someone’s in really chronic pain they have a cascade of protective reactions and we start to unpick some of those and work out which ones may not be really needed. “In that process the person gets much more movement and feels much more like herself. So the pain, instead of being allconsuming, starts to move out of central focus. People come to me with chronic pain but rather than discussing pain we talk about what they’d like to be able to do or what they are having trouble doing, so that pain is no longer the central part of the discussion. Contact Janet Auret on 6629 1589; fax 6629 1670.

Book: Healing the Heart and Mind with Mindfulness By Malcolm Huxter, Routledge www.routledge.com (Also available at amazon.com)


uddhist practitioner and Lismore clinical psychologist Malcolm Huxter has written a practical book that provides strategies using mindfulness to manage stress, anxiety and depression, and cultivate psychological wellbeing. In a unique blend of Eastern and Western wisdom, Malcolm uses his extraordinary depth of knowledge to outline how the August 2016 healthspeak

Buddha’s four applications of mindfulness can provide a pathway to psychological wellbeing and how this can be used personally or in a healthcare setting. Malcolm’s sincere and easy to digest approach is a must read for therapists and others who wish to understand the roots of mindfulness and how it’s related to wisdom, compassion and ethical behaviour.

Included are chapters on purpose, meditation, mindfulness of thoughts, emotions, reactive cyclic patterns and how to break free from them, presence, practice and aspirations for the future. The practices are clearly explained and supported by real life stories. Being aware that mindfulness and meditation are simple but not easy, Malcolm guides the reader from the basics of mindfulness

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and meditation through to the more refined aspects. Also provided are a number of different exercises and guided meditations which can be streamed or downloaded online. Through examples and practical applications, Malcolm does an excellent job of integrating the Buddhist understanding of our human condition and its use of mindfulness with the modern cognitive and behavioural psychology practiced today. For the reader who is ready, this is a life-changing book. 29

Professional training for the health sector


he Northern Rivers Social Development Council (NRSDC) has been delivering community services in Northern NSW for more than 40 years, but it’s not well known that NRSDC also provides professional development and training in the health services and community sectors. NRSDC’s Training Coordinator Gabe Morahan said customised in-house training can be organised to meet particular training needs. “Through partnering with experts in the field, we can save managers considerable time, money and stress. We take on all the administrative tasks involved in running your staff training,” said Gabe. NRSDC offers expertise in sourcing trainers, marketing courses, finding venues and administrating the delivery of courses to help your staff access relevant and well-designed training. NRSDC’s in-house training service delivers a range of innova-

tion and its staff. All professional development training sessions are interactive, based on adult learning principles and are facilitated by experienced trainers. Training can be delivered anywhere across the Northern Rivers. Contact our Training Coordinator at training@nrsdc. org.au or call 02 6620 1810 or 0439 137 207.

tive, creative and flexible training programs and is a cost effective solution for small businesses and organisations. “One of the important aspects of any organisation is the ability to change and adapt as the people you work with change and adapt so that you can ensure that you are meeting their needs. We are responsive in our program and will often place training on our calendar due to specific requests from our audience. People might

see a particular training on our calendar and then request that we offer it as an in-house training specific to their organisation. We are happy to do that and have a lot of experience doing it,” Gabe explained. The NRSDC training program is a expanding component of its core business. NRSDC’s diverse range of in-house professional development training can be tailored to suit the strengths, challenges and needs of your organisa-

Greenmeadows campaigns against antibiotic resistance


general practice in Port Macquarie has joined with NPS MedicineWise to create awareness around the overuse of antibiotics. In June, Greenmeadows Medical Centre staff wore purple NPS t-shirts labelled Antibiotic Resistance Fighter to get the conversation going with patients about the 29 million antibiotic prescriptions written in Australia each year. The Centre’s NPS MedicineWise clinical services specialist Lesley Burrett explained that a lot of prescriptions given out for antibiotics were unnecessary. “We know that resistance to antibiotics is a world wide problem,” said Lesley. In the general community there is a mistaken perception that antibiotics are a cure all, despite their lack of effectiveness 30

From left: pharmacist Lesley Burrett; Dr Tetyana Seppi, Dr Anthony Wan, Dr Madeleine Holloway, Dr Nevenka Stancevic, Dr Julia Edmund, Dr Robert Clarke and Dr Chris Timms

against viruses such as those causing the common cold. Community members can help tackle the problem of antibiotic resistance by not expecting antibiotics when they present with virus and only taking antibiotics which are prescribed. Due to the overuse of antibiotics, infections that were

once easy to treat are becoming untreatable, a worrying development. Greenmeadows’ GP, Dr Robert Clarke said that while infections were a common presentation, it was important to work out the type of infection and the best treatment for that infection, which might not be antibiotics.

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Coraki Health One building starts soon


orthern NSW Local Health District has awarded the building contract for the new $4 millionCoraki Health One facility. Woollam Constructions has been awarded the contract and has already taken control of the site. “The awarding of the building contract is a major milestone for the construction of the Coraki Health One facility, and marks several years of community consultation” NNSW LHD Chief Executive Wayne Jones said. Ms Lynne Weir, Executive Director Richmond Clarence Health Service Group paid tribute to the Coraki Health One Community Reference Group who have worked with the NNSWLHD and the community since this announcement and she thanked them for their involvement and their continued contributions. “The Health One facility will meet the primary and community health care needs of the residents of Coraki and surrounding area now and into the future, Mr Jones said.” healthspeak August 2016

Grey power and equity A

re we set for a period of inter-generational warfare? It’s probably too early to say but certainly the seeds of war are there and the ground is fertile. Intergenerational clashes are quite common in history as the young wrestle control from the old. But this time it’s a little different. That large bulge in our population that comprises the baby-boomers is in the process of retiring. And in democratic western countries they have the numbers to swing elections should they choose to do so. The question is: will they use their political power in a democracy to skew policy making to their own benefit - and to the detriment of those who are younger? The answer is “yes”. In fact it’s already happening. Baby boomers are flexing their ageing muscles in the ballot box and it is leading to serious inequities. If it continues then tensions are likely to rise. The Brexit is a clear example of grey power. While the vote was reasonably close there was a clear divide between the attitudes of the young and the elderly. We know from surveys that young people in the UK were overwhelmingly pro-European while older Britons were not. Only 36 per cent of those aged 18 to 24 bothered to vote compared with 80 per cent for those over 65. The combination of their greater numbers and the fact that older people tend to be more politically active, turned the vote. Many young Britons now feel their future has been compromised and are blaming their parents. But it doesn’t stop there. In the European Union there are 130 million pensioners and if they decided to act together to protect their interests they August 2016 healthspeak

Entitlements paid to the elderly are skyrocketing forcing even higher levels of US government debt could determine the outcome of any election. The same power dynamics exist in the US and Australia. Even if the elderly do not rally in excited mobs, they have a power that makes politicians tread very carefully. Everyone agrees that pensions in the EU are far too generous but with the exception of Greece no country has seriously cut pensioner benefits despite calls for austerity and huge budget deficits. In the US many city municipalities are going broke because of overly generous pension schemes granted to their baby boomer employees. Entitlements paid to the elderly are skyrocketing forcing even higher levels of US government debt.

In Australia those aged 65 and over are the fastest growing population segment. They represent 15 per cent of the population and will grow to more than 25 per cent by mid-century. As a proportion of the voting population they will be even larger. Eighty per cent of those 65 and over are on a full or part age pension and this is not expected to change. The elderly also put greater demands on the health system. Cutting the health budget is a risky proposition. In addition the elderly have a firm grasp on the nation’s wealth, mainly through real estate and superannuation investments. Meanwhile the young are finding it almost impossible to enter the housing market with first home buyers at record lows. They are also being forced to pay handsomely for their education and accumulating large debts. Climate change too is an intergenerational issue. Babyboomers have won handsomely from strong economic growth over the past thirty years but the cost of this growth in terms of climate change will be borne by

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finance David Tomlinson younger generations. In addition the job market today for young people is extremely difficult – a far cry from the job stability baby boomers enjoyed. Despite this there have been serious calls for cuts to unemployment benefits while leaving generous tax concessions to the elderly untouched. Trying to change all this will be difficult in a democratic country. Now none of this might matter much if we had strong economic growth and more importantly, strong productivity growth. But over the next few years, even decades perhaps, economic growth in developed countries is expected to be modest, even stagnant. Trying to be more equitable when the economic pie is shrinking will be a challenge. But something will have to give in terms of reducing intergenerational inequity. If not, things could get interesting.


Spending on palliative med services jumps


ver the past five years, MBS payments for all palliative medicine specialist services increased by almost 80%. In 2014-15, 13,000 patients received an MBS-subsidised palliative medicine specialist service, with around 71,500 of these services provided nationally at a cost of $5.3 million paid in benefits, according to an Australian Institute of Health & Welfare (AIHW) report. The report, Palliative care services in Australia 2016, shows

that palliative care hospitalisations increased by 11% from 55,983 in 2009-10 to 62,164 in 2013-14, but accounted for less than 1 in 100 of all hospitalisations for both public and private hospitals. “As the Australian population grows and people live longer, the demand for palliative care services will increase,” said AIHW spokesman Tim Beard. “These services provide relief from pain and other distressing symptoms for people who are dying. Such services are in

New allied health building at SCU, Coffs

Southern Cross University Vice Chancellor Professor Peter Lee, federal Member for Cowper Luke Hartsuyker, Coffs Harbour City Council Mayor Denise Knight and Chamber of Commerce President George Cecato.


outhern Cross University has welcomed a $12 million investment from the Coalition government for stage one of a new allied health building at the Coffs Harbour campus. Vice Chancellor Professor Peter Lee said it was fantastic news for Coffs Harbour. “This is an exciting day for the University and the Coffs Harbour community. This investment will enable us to proceed with stage one of our allied health building, paving the way for new courses and facilities for students and the community,” Professor Lee said. 32

“We will introduce degrees in speech pathology and occupational therapy and establish the SCU Health Clinic, an innovative model of providing community care and professional experience for our students.” Professor David Lynch, head of the Coffs Harbour campus, said the concept for the allied health building was well-developed. “We are shovel-ready for this project. The funding will enable us to complete stage one and we will continue to look for funding opportunities to complete the additional stages.”

increasing demand as patterns of disease at the end of life change. “An increasing proportion of Australians are suffering from chronic illnesses, and people are therefore more likely to die from chronic illnesses and make use of palliative care services,” he said. The most common principal diagnosis for palliative care

hospitalisations was cancer (53%), which accounted for 1 in 25 (4%) of all cancer-related hospitalisations. Palliative care-related hospitalisations also accounted for nearly one-third (30%) of all hospitalisations with a principal diagnosis of pancreatic cancer, followed by lung cancer (29%) and liver cancer (20%).

New RACGP President


asmanian GP, Dr Bastian Seidel, has been announced as President-elect of The Royal Australian College of General Practitioners (RACGP). Dr Seidel, who will take over the role from current RACGP President Dr Frank R Jones in September, has vowed to build on the RACGP’s growing public profile to ensure general practice remains at the heart of public dialogue on health. “I am absolutely delighted and honoured to have been elected by our members to this important role and look forward to making a positive impact on behalf of Australia’s general practitioners, our college and our patients,” he said. “With general practice funding increasingly under


Folic acid in bread paying off Mandatory fortification of bread with folic acid and iodine, introduced here in 2009, has resulted in improved health outcomes, particularly for teenagers and Aboriginal and Torres Strait Islander women, according to a report from

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Dr Bastian Seidel

threat the role of the RACGP in representing and communicating the interests of members and patients has never been more important.” Dr Seidel praised incumbent RACGP president Dr Frank R Jones for his achievements. “I will endeavour to be as passionate and vocal in advocating for primary healthcare as Dr Jones but he will be hard act to follow.”

the Australian Institute of Health and Welfare. The report shows that there was a significant (14.4%) overall decrease in the rate of neural tube defects (NTDs) in Australia following fortification. However among teenagers, the rate of NTDs decreased even more, by almost 55%, and for Aboriginal and Torres Strait Islander women, the rate of NTDs decreased by 74%.

healthspeak August 2016

Across the road and over the mountain ‘ I’d prefer a new edition of the Spanish inquisition or a dentist to be drilling…’ Remember Rex Harrison in that old musical My Fair Lady? It rings true with my childhood memory of the dentist in 1958, those early experiences leaving me with an irrational fear of dental work. The slow speed drill was actually pedalled by a huge dentist on a bicycle stool as he gouged my dental pulp. He threatened me one day with a horse gag if I could not keep my mouth open. Then- progress - he had electricity. It didn’t help much. Maybe it was worse as he was not distracted by pedalling and could apply his evil pressure faster. I must admit, I feel much more relaxed these days, because my lovely dentist has the nitrous oxide option. Early in my career, I was a busy GP anaesthetist. I know something of nitrous oxide and have administered a lot of this analgesic gas to unconscious patients, during lengthy operations, as a total respiratory replacement for inert atmospheric nitrogen. To the anaesthetist, the floating, twirling, flowmeter bobbins gave constant re-assurance of the necessary 25% oxygen additive. Nitrous oxide must be considered an amazingly safe agent to use, so much so that dentists can use it without the presence of an anaesthetist. In the conscious patient this ‘laughing gas’ can enable happy sensations, but dosage to response is vital and the dentist told me that some people can become panicky or disoriented. It’s not for everyone. One day recently at the dentist’s, the nurse told me of her uncle who was in pain with a terminal illness. Did I know how to get some medicinal cannabis for him? She had been asked and wanted to help if possible.

August 2016 healthspeak

Articles in the local paper refer to the Nimbin Hemp Embassy so I suggested she start there. It did however arouse my curiosity and I asked some friends whom I thought might be in the know. ‘No problem really,’ I was told. ‘You can buy it openly in the computer repair shop’. That was a surprise. Next time in town, I wanted to verify this, except my computer was working quite well, denying me an excuse to shop. I went in anyway. To my surprise, there was large sign advertising the sale of CBD oil. The young man behind the counter was very helpful and said it was almost legal because the oil did not contain THC, though expensive at $280 for a small bottle. He even gave me his card. I was telling a friend about the whole confusing issue and she replied with a parable. A tourist in an Islamabad restaurant ordered the chicken. Examination of the dish revealed it to be suspiciously mammalian and when questioned as to if it was truly chicken, the waiter replied, ‘Ah Sir, but it is nearly chicken’. So, it seems that maybe ‘oils ain’t oils’ and further research was needed. According to my Apple Mac (the one not needing repairs) trials done at Kings College in London showed that 10mg of THC (tetrahydrocannabinol) caused psychological and behavioural differences but 600 mg of CBD (Cannabidiol) did not cause these effects rather it relieved pain, improved sleep, controlled fitting and enabled a sense of relaxation. THC, something any GP knows, accentuates psychosis. According to the researchers these effects are ameliorated by CBD. It will be interesting to see the results of trials already underway with the NSW Government. In the meantime I have

heard a fair amount of anecdotes that people who believe the early claims are already voting with their feet. Suffering does not wait. At my next dental appointment, I told the nurse the news that it might be available across the road but she told me she had already taken my advice and gone over the mountain to Nimbin. She reported that the Hemp Embassy was very helpful and a nice hippy had directed her downstairs. ‘Just go through the green door’. ‘It was quite crowded in there,’ she reported as I started to relax for the dreaded filling, ‘full of straight people from Brisbane’.

light airs David Miller

The young man said it was almost legal because the oil did not contain THC, though expensive at $280 for a small bottle

Editor’s note: The Australian parliament passed national laws paving the way for the use of medicinal cannabis by people with painful and chronic illness earlier this year. Under the new scheme, patients with a valid prescription can possess and use medicinal cannabis products manufactured from cannabis legally cultivated in Australia, provided the supply has been authorised under the Therapeutic Goods Act. The changes put medical cannabis in the same category as restricted medicinal drugs such as morphine.

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Dying: A Memoir Cory Taylor Text $27.00


learly, Cory Taylor was alive when she penned this insightful and elegantly presented book, but as the title indicates she was certainly not well, having been diagnosed with terminal, melanoma-related brain cancer. “Cancer strikes at random,” she notes, pragmatically. “If you don’t die of cancer you die of something else, because death is a law of nature.” Quite so, but it is the way one’s death occurs, and to an extent why, that guides her musings, if that is not too light a term. For instance, what if she had been more vigilant about checking her skin, “because if I had been, I would have picked up that first melanoma before it turned bad, and saved myself a lot of heartache.”

Another ponderable entails a near-death experience when a teenager’s speeding car had brake failure, ran a red light and ploughed into her parked vehicle a split second after she had stepped out. A bystander said she had been a millimeter away from losing her legs. Now, aged 60, house-bound, weighing “less than the neighbour’s retriever” and coping with a terminal diagnosis, she writes, “So many times I’ve wondered what might have happened to me if I had lost my legs, or even just my right one, where my first melanoma appeared two or three years later. “If I’d just been a second slower stepping away from the car, I might not be dying now. I’d be legless, of course, but still in good health.” Yet this is much more than a catalogue of what-ifs, tempting as it may be “to envy the life of the alternative me” who looked like settling permanently in Paris, or becoming an expert in the constitutional history of NSW when studying at Oxford. Rather, it is a clear analysis of the dying process and another important contribution to the debate about drug assisted euthanasia. In the latter regard, Taylor, a highly regarded writer (of the acclaimed novels Me and Mr Booker, and My Beautiful Enemy)

book review Robin Osborne echoes the views of longtime MS sufferer and North Coast author Gillian Mears who died recently. She wonders if medicos’ aversion of assisted dying “might stem from a more general belief… that death represents a form of failure… (and) can be banished from our consciousness altogether.” An attendee of Exit meetings, she possesses drugs bought online from China, kept in a vacuum-sealed bag in a secret place, along with a suicide note, and contemplates the ease with which she could end her life. No doubt swallowing a fatal dose and never waking up would be preferable to facing a “lingering and gruesome demise”. Yet she hesitates, mindful of the emotional impact on those “unfortunate enough to discover my corpse.” It worries her that the death certificate would list ‘suicide’ as the cause of death, “with everything that the term implies these days: mental angst, hopelessness, weakness, the lingering whiff of criminality - a far cry from, say, the Japanese tradition of seppuku, or suicide for honour’s sake [her

husband Shin is Japanese]. “The fact that cancer was actually my killer would be lost to posterity, as would be the fact that I am not, by any fair measure, mad.” Taylor’s mother was also a supporter of assisted dying, but by the time she was lost to dementia “had left it too late to put theory into practice.” So was her father, an airline pilot whose erratic lifestyle dragged the family across the world, who suggested sailing out into the Pacific and drowning himself. He even asked his wife to buy a half share and to crew for him. In one of her flashes of humour, Taylor writes, “Maybe they should have sailed off into the sunset never to return; instead they lived on and died badly.” She is determined not to share this fate, so keeps her stock of drugs while engaging the help of a valued palliative care team that includes volunteer biographers who record patients’ stories and present a bound copy of the finished product to the families of the dying. It hardly seems necessary to extend this service to an author whose memoir offers as much insight and reflection as anyone could deliver in just 150 pages. Cory Taylor died on July 5 ‘peacefully, at home and surrounded by friends’.

CVD rate falls by one-third


here have been good gains in the health of the Australian population, with the overall burden of disease and injury reducing between 2003 and 2011. According to the Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2011, released by the Australian Institute of Health and Welfare (AIHW), there was a 10% fall in the total fatal and non-fatal components combined. “This was mainly due to a 15% 34

fall in fatal burden - in other words people are not losing as many years from dying prematurely as before - but there was also a 4% fall in the non-fatal burden,” said AIHW spokeswoman and report co-author Dr Lynelle Moon. Among all the disease groups, the largest fall in the fatal burden was seen in cardiovascular diseases, where rates fell by nearly one-third. “We found that chronic diseas-

es such as cancer, cardiovascular diseases, mental and substance use disorders, and musculoskel-

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etal conditions still dominate in terms of total burden, along with injury,” Dr Moon said. “In fact, these 5 disease groups combined, accounted for around two-thirds of the total disease burden-69% in males and 62% in females. In terms of non-fatal burden only, mental and substance use disorders along with musculoskeletal conditions had the greatest impact, accounting for nearly one-half of the total non-fatal burden between them.” healthspeak August 2016

Increasing Cardiovascular Fitness with High Intensity Interval Training


hile there is nothing new about the use of High Intensity Interval Training (HIIT) to improve the performance of elite athletes, could the same principle be applied to someone who is overweight and sedentary? And indeed, HIIT would be ideal for busy unfit people who often cite a lack of time as the reason for not participating in exercise. Canadian study

A recent small study under researcher Professor Martin Gibala at McMaster’s University in Ontario, Canada, investigated whether sprint interval training (SIT) was a time efficient strategy to improve insulin sensitivity and other indicators of cardio-metabolic health to the same extent as traditional moderate intensity continuous training (MICT).

The exercise component

The SIT involved 3x20 second ‘all out’ sprints (~ 500W) interspersed with 2 minutes of cycling at 50W, whereas MICT involved Andrew 45 minutes of Binns continuous cycling at ~70% maximal heart rate (~110W). Both protocols involved a 2 minute warm up and a 3 minute cool down. The major novel finding from the study was that 12 weeks of SIT in previously inactive men improved insulin sensitivity, cardio-respiratory fitness and skeletal muscle mitochondrial content to the same extent as MICT. This was despite a fivefold lower exercise volume and training time commitment.

Sedentary Lifestyle

reduced aerobic capacity reduced mitochondrial number


insulin resistance and diabetes cardiovascular disease (CVD)

Similarly effective

SIT involved 1 minute of intense intermittent exercise within a time commitment of 10 mins per session whereas MICT consisted of 50 minutes of http://tinyurl.com/jflwl5c continuous exercise at moderate pace. There was a similar In the study, SIT involved 1 19% improvement in V02 peak minute of intense stationafter 12 weeks of SIT ary cycle exercises and MICT which within a 10 minute compares favourably Look out for stairs time commitment. with the typical to climb and In contrast, MICT change reported afascend as quickly involved 50 minter several months as possible utes of continuous of traditional endurexercise per session. ance training. The study went over 12 So, how could these weeks with sessions three times findings be used to give advice weekly. to people in everyday life? Despite the association beThere are many ways a version tween low amounts of physical of this type of activity could be activity and an increased risk incorporated into the lives of of many chronic diseases, the even the most sedentary people. prevalence of physical inactivFor example, look out for stairs ity is higher than that of all to climb and ascend as quickly other modifiable risk factors for as possible. If cycling, look for cardiovascular disease. August 2016 healthspeak

With a minimum time commitment, we can wake up those sleeping mitochondria, lose fat, improve insulin sensitivity & cardiovascular fitness

Aerobic, Resistance and HIIT Excercise

increased aerobic capacity increased resistance to fatigue increased endurance increased fitness reduced risk for diabetes reduced risk for CVD

steep hills rather than flatter ground. Adding some resistance training may also help to build muscle strength. Exercise & heart risk

One word of caution: there is always the risk of a major heart event with training whether intense or moderate. A large Norwegian study of people who had already had a heart event were put through high intensity training and moderate intensity exercise in a cardiovascular rehabilitation setting.

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http://circ.ahajournals.org/ content/126/12/1436.full Among the 4,846 patients, a total of 175,820 exercise sessions lasting ≈1 hour were recorded, distributed on 129,456 hours of moderate-intensity exercise and 46,364 hours of highintensity exercise. Overall, the incidences included one cardiac arrest with fatal outcome during moderate-intensity exercise and two non-fatal cardiac arrests

Continued page 35 35


Making connections through art


ealthSpeak visits artist Lorraine Abernethy at her Bilambil Heights home. A vibrant woman with an infectious enthusiasm for all things creative, it’s clear Lorraine’s passion for art has been lifelong. “I was born in Armidale and came here when I was six. My mother was a painter and my grandmother taught me to sew and knit and crochet. The artist brings out several of her ‘soul dolls’ for me to look at. These are soft form dolls created to represent where a person is at in their life. They can be an archetype – dolls that contain a person's inner wisdom and their personal medicine which may be accessed at any time. Lorraine explained that these soul dolls reference play when she was a little girl and used to like making dolls’ clothes. “Art is a place of refuge for me, you can enjoy your own space and I got a lot of praise as a child in relation to doing stuff, so that shapes you too,” said Lorraine. Lorraine studied art when her children began school and then focused on art exhibitions and teaching. A series of challenging losses in her life – a divorce, the death of a partner, and the death of her eldest son– became a path on which Lorraine became equipped to teach more holistically, with more awareness and understanding. “This doll is one of about thirteen I’ve made, a ‘Mother’, she’s pregnant with ideas and creativity and has a soft tummy, She’s also a winter doll, a good time to incubate ideas.” Lorraine uses the dolls in her Art as Healing Workshops and as one art form offered at weekly workshops she runs for people with mental illness; workshops she’s run now for 14 years. The dolls came out of Lorraine’s training in transpersonal art therapy which focuses on 36

self-realisation and facilitates personal growth, giving a sense of meaning to the participant. “The product [artwork] is something that you are moving along towards, but the journey is so much more important, and hence the healing aspect and the curiosity about life and what it brings up for you…I encourage people to look within at their own inner journey as well as their outer journey. I like the analogy of being Alice jumping down the rabbit hole and you don’t know where you are going or who you will meet,” Lorraine said. Lorraine enjoys her Tuesday Connections workshops for those with mental illness auspiced by On Track because she never knows who’s going to turn up. “The participants might be dealing with physical and mental disabilities and I learnt a long time ago that you don’t

the focus of getting into something they enjoy. “Doing something creative helps to still the mind and helps Lorraine Abernethy reduce their stress or at her home in anxiety. It can also Bilambil Heights with some of her help them to become soul dolls more mindful. “I find people start sharing their stories, too, because they feel safe. There might be someone new in the group feeling a bit vulnerable and sharing can help them relax.” Because Lorraine has been leading the group for so long, for a lot of the participants it’s like their home, ongoing, safe and with a strong sense of family. She says working with participants whose ages are from 25 through to 70s is very different from working with her art students in more formal workshops. “In the Connections workshops it’s always a bit of a struggle to do an art project. My come in with a big plan. I always role is about supporting them as have painting and drawing maa facilitator, walking with them. terials and then I broaden it by You can help to direct them on offering some mosaic work. For some things, but if they don’t example, making mosaic cut out want to go there, that's OK. It’s hearts or other wooden shapes. not like art school where you “We did a project have to complete an art where we created project, it’s very flexmosaic around ible.” a garden bed Some very years ago. There might be talented people I also got someone new in the have been the guys group feeling a bit through the to paint vulnerable and sharing Connections can help them relax tables with art workshops. colourful “Several young images like a people who come mural, which was regularly, they’re then sealed, and now very talented and I have we’ve just stripped the tables sold a lot of their work at the back and painted them white, art exhibitions we have had. As ready to redo them again. We’ve an artist, it gives one a sense of also created some murals on the self worth to have your work outside of the building.” purchased and acquired. A Feedback from her On Track reinforcement of what you are groups informs Lorraine that doing. people like the quiet atmo“Another young person is sphere, being with others and

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Continued page 39

healthspeak August 2016


Coffee: why you can enjoy it every day


s coffee part of your lifestyle? bean, while the espresso drinkDoes the first cup of coffee in ers enjoy the Arabica, with just the morning make you feel norhalf the caffeine. Go over the mal? Do you get the odd muscle 400g mark (about four cups of twitch with your fourth cup of espresso) and you may be enterthe day, or a headache ing serious diuretic terriif you go without it? tory, with leaching of Welcome to a select minerals and water band of coffee soluble vitamins, drinkers called the perhaps gastritis Chris Ingall majority. You are, and anxiety, and in along with the 46% the long run osteoof Australians who porosis. drink coffee, and the Many drinkers mix 38% of Australians who drink it up, having an espresso if one tea, up for a stimulant. is handy and drinking Instant You are more likely to be pro- when it isn’t. Stopping by the ductive in the hour or so after local coffee shop on the way to your flat white, less irritable and work, lashing out and buying an more relaxed; in the long run espresso machine for the office less likely to succumb to cirand even going out for a break rhosis from your alcohol intake, between patients are all ways we and at lower risk of Parkinson’s have a better cup, the pressure disease, renal and gall stones. So extracting flavour and the short go ahead and have one or two, marriage between water and and maybe even three, but four roasted, ground bean minimismay be stretching it. ing bitterness. Perfect really. It is not only caffeine which The time of day is what gets exerts positive effects, but other me, with nadirs occurring regualkaloids and substances in the larly at ten in the morning and bean, such as clorogenic acid two thirty in the afternoon. I and caffeic acid (type 2 diabetes have my latter coffee just before protection) and kahweol and I put my head down (yes even cafestrol (some cancers and if the waiting room is full) for a inflammation). Caffeine helps ten-minute nap, and waken as performance before fresh as, well, a daisy. exercise, and I understand the possibly muscle science behind recovery after, this is the The bean has been with especially coffee takes us for many centuries, with water about fifteen and has allegedly excited goats, birds and donkeys and some minutes to along the way to its glucose. Go kick in, which discovery the lycra latte! is about the Having said time I wake. that, the studies The sleep lowers are mainly metamy adenosine levels analyses, and we need then the coffee binds the some good controlled studies molecule’s receptor, ensuring of lower doses of coffee for about an hour of energetic clarordinary drinkers. ity. A coffee nap, no less! If you are one of the two Here on the North Coast thirds of coffee sippers who we are blessed drink Instant you can have up to with many five cups, as that gives you the fine producers estimated maximum 400g cafof coffee, and feine for the day, but you will be have our pick drinking the inferior Robusta of plantation August 2016 healthspeak

or shade coffee, the latter existwith civilisation from its begining in a rainforest environment nings in Ethiopia to its spread and arguably making a gentler, across the planet today. We are a more flavoursome brew. Higher lowly 42nd in the world per capaltitudes and hotter climes exert ita consumption, so we need to the plant to infuse the bean get cracking and lift our game. with more caffeine, which is by Our patients will thank us! the way an insecticide which protects the leaves. Our lower, milder terroir gives a naturally lower level of caffeine, which I prefer. So what to tell our patients? If they notice gastrointestinal sympIt is not only caffeine toms at either which exerts positive effects, but other alkaloids end soon after and substances in the imbibing, bean, such as clorogenic caffeine may acid and caffeic acid be the culprit. Irritable bowel syndrome, heartburn and a sensation of oesophageal reflux are not uncommon, so advise them accordingly. Sometimes an adjustment in dose is all that’s needed. A maximum of 400g each day and 200g if pregnant is a good rule of thumb, and the vast majority of people will enjoy their coffee untroubled. The bean has been with us for many centuries, and has allegedly excited goats, birds and donkeys along the way to its discovery, so it has married well

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Caffeine in soft drinks and energy drinks: Health implications for children


ost parents wouldn’t depression. Studies are now dream of giving their linking consumption of caffeinkids a mug of coffee, but might ated and energy drinks with the routinely serve soft rise in childhood obesity. drinks containing Soft drinks and energy caffeine. A stimudrinks generally By Anna Huddy lant that affects include a massive Program Coordinator children and adults dose of sugar. This – Healthy Eating similarly, caffeine is can result in a tenActive Living Team, NNSWLHD naturally produced dency not to eat or in the leaves and drink better sources seeds of many plants. It of nutrition which can is defined as a drug because it result in significant implicastimulates the central nervous tions for weight gain, but also system. At lower levels it can importantly for malnutrition. A enhance alertness and make variety of nutrient rich foods are print ‘‘Consumption should not exceed one can per day”, yet people feel more energetic. vital for growing children and they are sold in a four-pack. These principal effects may be young people. There is no Acceptable Daily seen as beneficial in moderate Alarmingly, in 2013 the Intake for caffeine. However, a doses for adults, but what about American Association of Poison literature search by the Expert the effects for children? The Control Centres reported the Working Group of Food Stanquestion, which has become a highest number by far (879) dards Australia New Zealand matter of research and consider- of energy drink overdoses in (Oct 2014) provides evidence able debate is, how does this children aged 5 or under. Many of increased anxiety levels in affect their health? countries have banned the sale children at doses of about 3 Caffeine is a drug with no of energy drinks to minors due mg of caffeine per kilogram nutritional value. Sugar, also to energy drink related deaths of bodyweight per day. This addictive, contains nothing but and other adverse effects, equates to a caffeine kilojoules. The combination of yet such a ban dose of 95 mg per caffeine and sugar, along with has not been day (two cans a few other ingredients such as imposed in Children hooked on of cola) for guarana, theobromine, theophAustralia. caffeine can suffer children aged ylline, taurine, ginseng, amino The Austrawithdrawal symptoms 5-12 years and acids and vitamins, typically lian Medical such as headache, about 210 mg make up the highly marketed Association sleeplessness, irritability per day (three products called ‘energy drinks’. has backed and depression cups of instant For more than 30 years caffeine calls to ban coffee) for adults. consumed by children in the this type of In 2010 the form of soft drinks and energy drink. American Academy drinks, has skyrocketed. Since For adolescents of Paediatrics recommended energy drinks were introduced and young adults, mixing that children not consume into the Australian market energy drinks with alcohol drinks with caffeine loads about 15 years ago there have increases the potential harm as greater than 50mg/serve. The been several poisonings in the caffeine can mask the effects Australian Food Standards young children as a result of acof intoxication, making the Code (AFSC) states that energy cidentally consuming them. consumer feel more alert and drinks must contain no more Caffeine added to sugary less drunk (CHOICE article). than 32mg of caffeine per drinks disrupts neural developMixing energy drinks with 100ml. However, most 250ml ment and increases anxiety, alcohol increases dehydration. bottles of energy drinks have leading to abnormalities in A 16 -year-old Australian girl about the same amount of cafbehaviour and socialisation. died in 2002 after consuming feine as an espresso shot and Children hooked on cafthree cans of a branded pre-mix many energy drinks contain 2 to feine can suffer withdrawal of soda, vodka and guarana in 3 times the amount of caffeine symptoms such as headache, just over an hour. The preas in cola soft drinks (CHOICE sleeplessness, irritability and mixed can states in very small 38

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article 2014). Thankfully the AFSC states that energy drinks must also carry the warning label, "Contains Caffeine, Not Recommended for Children, Pregnant or Lactating Women and Individuals Sensitive to Caffeine”. The key to the problem with caffeinated food and drinks loaded with sugar is not the individual dose but the effect on long-term, continuous consumption. There is currently no health policy or even public awareness about limitations of caffeine for children and adolescents. This leaves the responsibility to parents who must monitor their children’s intake – difficult to do with so many sources of caffeinated beverages and foods now readily available and skilfully marketed.

Write for HealthSpeak Are you interested in writing an article for our new Health & Lifestyle section? We’d love to hear from you. Get in touch with Editor Janet Grist on jgrist@ncphn.org.au

healthspeak August 2016

From page 36

very talented with cartoons and has a strong sense of purpose in what he does.” And it's not just young people, several of the elders have created stunning works of art as well. The Connections participants are often mostly men, which Lorraine said is a bit unusual for a creative group. “I’m often amazed at how many men come to Connections where we may have conversations that lead to more internal things, such as loneliness, or the difficulty of living with an illness.” The participants have a range of mental health disorders such as bipolar, schizophrenia, anxiety, depression etc. Although her Connections clients sometimes ask to be taught art, Lorraine prefers to engage them more gently. “There is a great art move-

ment called Outsider Art. This is artwork created by people who live on the margins of life with little or no formal art training. Like Outsider Art, I don’t teach art to these people. Formal training can stifle a person. I’ll show them a few technical ways to approach something if they wish, but it’s so important to engage them in being creative, allowing their individual creativity to have an outlet, whatever that strength is.” Lorraine and her artist husband Ian Tremewen recently spent a couple of months in The Maldives as Artists in Residence, creating and teaching art to visitors and locals. Find out more about Lorraine’s art classes, workshops, exhibitions and view her work at: www. goldcoastartclasseswork shopsnorthernnsw.com

From page 35

Check CV health first

The results of this study concluded that the risk of a cardiovascular event is low after both high-intensity exercise and moderate-intensity exercise. Considering the significant cardiovascular adaptations associated with high-intensity exercise, such exercise is worth considering for patients with coronary heart disease as well as those who are healthy but sedentary. However, there should be an appropriate cardiovascular check up first. So maybe there is a message here for all of us? With a minimum time commitment, we can wake up those sleeping mitochondria, lose fat, improve insulin sensitivity and cardiovascular fitness. And there are no time excuses about fitting this activity into a busy schedule.


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Profile for North Coast Primary Health Network

Healthspeak August 2016  

North Coast Primary Health Network is a not for profit organisation established to respond effectively to local health care needs. Focussed...

Healthspeak August 2016  

North Coast Primary Health Network is a not for profit organisation established to respond effectively to local health care needs. Focussed...

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