ISSUE 1 Spring 2012
Valley Coffs Harbour Bellingen Nambucca Kempsey Hastings Tweed Kyogle Kempsey Hastings Tweed Kyogle Lismore Byron Richmond Valley Ballina Clarence Richmond Valley Ballina Clarence Valley Coffs Harbour Bellingen Nambucca Harbour Bellingen Nambucca Kempsey Hastings Tweed Kyogle Lismore Byron Tweed Kyogle Lismore Byron Richmond Valley Ballina Clarence Valley Coffs Ballina Clarence Valley Coffs Harbour Bellingen Nambucca Kempsey Hastings Nambucca Kempsey Hastings Tweed Kyogle Lismore Byron Richmond Valley A publication of North Coast NSW Medicare Local Lismore Byron Richmond Valley Ballina Clarence Valley Coffs Harbour Bellingen Valley Coffs Harbour Bellingen Nambucca Kempsey Hastings Tweed Kyogle Kempsey Hastings Tweed Kyogle Lismore Byron Richmond Valley Ballina Clarence Richmond Valley Ballina Clarence Valley Coffs Harbour Bellingen Nambucca Harbour Bellingen Nambucca Kempsey Hastings Tweed Kyogle Lismore Byron Tweed Kyogle Lismore Byron Richmond Valley Ballina Clarence Valley Coffs Ballina Clarence Valley Coffs Harbour Bellingen Nambucca Kempsey Hastings Nambucca Kempsey Hastings Tweed Kyogle Lismore Byron Richmond Valley Lismore Byron Richmond Valley Ballina Clarence Valley Coffs Harbour Bellingen Valley Coffs Harbour Bellingen Nambucca Kempsey Hastings Tweed Kyogle Kempsey Hastings Tweed Kyogle Lismore Byron Richmond Valley Ballina Clarence Richmond Valley Ballina Clarence Valley Coffs Harbour Bellingen Nambucca Harbour Bellingen Nambucca Kempsey Hastings Tweed Kyogle Lismore Byron Tweed Kyogle Lismore Byron Richmond Valley Ballina Clarence Valley Coffs Ballina Clarence Valley Coffs Harbour Bellingen Nambucca Kempsey Hastings Nambucca Kempsey Hastings Tweed Kyogle Lismore Byron Richmond Valley Lismore Byron Richmond Valley Ballina Clarence Valley Coffs Harbour Bellingen Valley Coffs Harbour Bellingen Nambucca Kempsey Hastings Tweed Kyogle Kempsey Hastings Tweed Kyogle Lismore Byron Richmond Valley Ballina Clarence Richmond Valley Ballina Clarence Valley Coffs Harbour Bellingen Nambucca Harbour Bellingen Nambucca Kempsey Hastings Tweed Kyogle Lismore Byron Tweed Kyogle Lismore Byron Richmond Valley Ballina Clarence Valley Coffs Ballina Clarence Valley Coffs Harbour Bellingen Nambucca Kempsey Hastings Nambucca Kempsey Hastings Tweed Kyogle Lismore Byron Richmond Valley Lismore Byron Richmond Valley Ballina Clarence Valley Coffs Harbour Bellingen Valley Coffs Harbour Bellingen Nambucca Kempsey Hastings Tweed Kyogle Kempsey Hastings Tweed Kyogle Lismore Byron Richmond Valley Ballina Clarence Richmond Valley Ballina Clarence Valley Coffs Harbour Bellingen Nambucca Harbour Bellingen Nambucca Kempsey Hastings Tweed Kyogle Lismore Byron Tweed Kyogle Lismore Byron Richmond Valley Ballina Clarence Valley Coffs Ballina Clarence Valley Coffs Harbour Bellingen Nambucca Kempsey Hastings Nambucca Kempsey Hastings Tweed Kyogle Lismore Byron Richmond Valley Lismore Byron Richmond Valley Ballina Clarence Valley Coffs Harbour Bellingen Valley Coffs Harbour Bellingen Nambucca Kempsey Hastings Tweed Kyogle Kempsey Hastings Tweed Kyogle Lismore Byron Richmond Valley Ballina Clarence Richmond Valley Ballina Clarence Valley Coffs Harbour Bellingen Nambucca Harbour Bellingen Nambucca Kempsey Hastings Tweed Kyogle Lismore Byron Tweed Kyogle Lismore Byron Richmond Valley Ballina Clarence Valley Coffs Ballina Clarence Valley Coffs Harbour Bellingen Nambucca Kempsey Hastings Nambucca Kempsey Hastings Tweed Kyogle Lismore Byron Richmond Valley Lismore Byron Richmond Valley Ballina Clarence Valley Coffs Harbour Bellingen Valley Coffs Harbour Bellingen Nambucca Kempsey Hastings Tweed Kyogle Kempsey Hastings Tweed Kyogle Lismore Byron Richmond Valley Ballina Clarence Richmond Valley Ballina Clarence Valley Coffs Harbour Bellingen Nambucca NCML on about Deadly living 8 All Harbour4Bellingen Nambucca Kempsey Hastings Tweed Kyogle13Lismore Byron film ATAPS Tweed Kyogle Lismore Byron Richmond Valley Ballina Clarence Valley Coffs Ballina Clarence Valley Coffs Harbour Bellingen Nambucca Kempsey Hastings Nambucca Kempsey Hastings Tweed Kyogle Lismore Byron Richmond Valley
Local community, local clinicians, local solutions NCML launch events page 15
Passion for People
Launching HealthSpeak Janet Grist Head Office
Suite 6 85 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Vahid Saberi Email: email@example.com Hastings Macleay 53 Lord Street Port Macquarie 2444 Ph: 6583 3600 General Manager: Paul Ward Email: firstname.lastname@example.org Mid North Coast Suite 2, Level 1, 92 Harbour Drive Coffs Harbour 2450 Ph: 6651 5774 General Manager: Sandhya Fernandez Email: email@example.com Northern Rivers Tarmons House 20 Dalley Street Lismore 2480 Ph: 6622 4453 General Manager: Chris Clark Email: firstname.lastname@example.org Tweed Valley 7 Nullum Street Murwillumbah 2484 Ph: 6672 5158 General Manager: Gary Southey Email: email@example.com
It is my pleasure to introduce the first issue of HealthSpeak, a publication of North Coast Medicare Local. Essential reading for North Coast health professionals and the community, HealthSpeak has evolved from newsletters produced by the four former Divisions of General Practice which make up the new North Coast Medicare Local – Tweed Valley’s The Network News, the Northern Rivers’ GPSpeak, Hastings Macleay’s The Network News and the Mid North Coast Medico. HealthSpeak will keep you up
Clinical Editor: Andrew Binns Email: firstname.lastname@example.org Display and classified advertising at attractive rates HealthSpeak is published four times a year by North Coast NSW Medicare Local Ltd. Articles appearing in HealthSpeak do not necessarily reflect the views of the NCML. The NCML 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 2012 North Coast NSW Medicare Local Ltd Magazine designed by Graphiti Design Studio Printed by Quality Plus Printers of Ballina
NCML’s bigger footprint, we are pleased to announce that HealthSpeak will also now be available to readers on a ‘turn the page’ digital platform, making it easy to read and accessible to a larger audience. If you would be happy to receive HealthSpeak electronically, please let me know. It will also help NCML cut production costs. And if you have a story suggestion, I’d love to hear from you. Please get in touch if you know of an interesting health professional, someone operating an innovative practice or an interesting research topic or would like HealthSpeak readers to know about a new health care service. Contact me on (02) 6622 4453 or email: email@example.com Happy reading!
A new beginning Chief Executive Officer
Editor: Janet Grist Ph: 6622 4453 Email: firstname.lastname@example.org
to date with all aspects of the primary care health community, including innovative services and health professionals, new clinicians, research and practice support advice. The magazine will be available in printed and digital form and on our website (www.ncml.org.au) and will be an important platform for discussion on health and wellbeing topics of all kinds. The month of June was a big one for NCML with 14 different launch events taking place across the North Coast of NSW. It was very encouraging witnessing the community interest in our new organisation and the enthusiasm from health professionals, local health district staff, hospital managers and academics about working with us to improve health outcomes. Read all about our launch events from page 15. With
It is another wonderful day in Northern NSW. You have in your hands the first edition of something new, special and unique to our region. Our own very first Primary Health Care Magazine – HealthSpeak. This is a publication written by those in the primary health care sector. It is for the entire community to read and enjoy and is put together by North Coast NSW Medicare Local. Broadly speaking, primary health care is the care provided in the community – outside the hospital sector. It is the general
practitioners, the psychologists, the pharmacists, physiotherapists and other allied health professionals. It’s also the specialists, dentists, optometrists and many others. We are a large group, by far the largest cadre of health professionals caring for the community. Together we are a formidable team. In a recent article Dr Tony Lembke and I wrote: “For the primary health care sector to release the collective power it has – to do good for the patient and the system – it has to act ‘as one’. Currently, there are too many silos and walls separating the sector. “Acting as one does not mean uniformity. It does not mean being stripped of volition or independence. It does not mean loss of autonomy or identity. It means liberation, interdependence and collective power. It is
what the bees, the ants, and entire ecosystems have perfected over millions of years.” What is this magazine’s role? HealthSpeak will help the community know what we are doing. It will allow us to share our stories, what we are up to, who is doing what and what we can learn from each other. This is your magazine, whether you are a clinician or a community member. And this publication will be richer for your contribution and involvement. North Coast NSW Medicare Local will work and collaborate with clinicians and the community to improve care in our region. We are keen to hear your ideas and thoughts. We will be establishing spaces for us to talk, exchange ideas and implement these. This magazine is one important way for us to connect.
HealthSpeak is kindly delivered by
The importance of being Local The slogan “Think globally, act locally”, once common on t-shirts and bumper stickers, is now seldom seen but the years have made it no less relevant. The problem is that thinking globally does little more than raise our awareness of international issues – global warming being an obvious one. Acting locally is a different matter. Locally is where we can have control, where we influence decision making, see the results of our efforts. A saying that gets MPs nodding is “All politics is local”. People vote in accordance with what most affects them, and a key priority is our health and that of our family members. For all of the mainstream media criticism about Australian health care – overly long emergency department waits, postponed surgery, etc – statistics show that our public health system, working in tandem with the private sector, has by global standards done an excellent job of helping the sick. One notable exception is in the field of oral health, with dentistry largely left out of the public funding equation. The Melbourne Institute’s recent Household Income and Labour Dynamics survey confirmed that while income level has no measurable effect on whether people will go to the doctor, people on low incomes are much less likely to visit a dentist than those on higher incomes because of the lack of government funding support. This is a major problem on the NSW North Coast, which has a disproportionately high level of social disadvantage and welfare reliance, and as medical practitioners are well aware, poor oral health has a direct impact on other physical conditions. Dentistry aside, Australians who need medical care are being relatively well supported in comparison to other developed nations. But this does not mean our health system cannot be managed better. For example, HealthSpeak
Federal MP For Page Janelle Saffin with Andrew Binns and Health Minister Tanya Plibersek at Lismore Base Hospital for the announcement of $60m in federal funding for the third stage of the hospital upgrade.
many people’s care could be better delivered at their home or in a community care setting than as a hospital inpatient, and more effort should be put into encouraging healthier lifestyles that will reduce the need for medical intervention. Responsible for coordinating the work of the former Networks of General Practice, as well as that of the Aboriginal controlled health organisations and the many providers of allied health services, such as physiotherapy, rehab, home nursing, social work and much more, the Medicare Local has a broad and challenging brief. The ambitious target of this new magazine, HealthSpeak, is to be as interesting and relevant to the region’s health professionals as it is to the broader community. It will be a forum to showcase the clinical news and views of our doctors, nurses and allied health workers, as well as opening a window through which all interested local people can see
how their health care is planned and delivered. Clear and open communication is an essential ingredient of good health care, whether between a patient and their GP, between the Commonwealth and state health authorities and Districts, or between a Medicare Local and its broader community. We see this as a key role of the magazine, especially at a time when quality journalism is under threat by concentrating media ownership, new technologies and falling advertising revenue. HealthSpeak will come out in magazine format as well as an online version for wider distribution. The magazine will start as a quarterly, at least in the early stages. Advertising that relates to health and wellbeing will be sought to help fund the costs of this publication. Contributors are also encouraged to contact us with suggested submissions. Feedback and letters will certainly be welcomed.
Research shows people on low incomes are less likely to visit a dentist than those on higher incomes.
Australian Lifestyle Medicine Association 4th Annual Conference Harbord Diggers, Freshwater, Sydney 2-4 November 2012 Sessions on sleep, exercise, nutrition, women’s health, environment and more For details and registration www.lifestylemedicine.com.au
Helping to meet Balund-a’s health care needs In late July a meeting was held at Balund-a Aboriginal Youth Correctional Centre, near Tabulam, to discuss the centre’s health care needs so that North Coast Medicare Local can look at bringing more practitioners to the centre on a regular basis. The Balund-a Program – which includes a working cattle farm - is an innovative residential diversionary program for male and female offenders between 18 and 40 years of age. Currently the centre has 22 male residents and one female resident, but has space for 70 residents and is looking to expand. It has a strong focus on cultural connection, literacy, life skills, substance abuse treatment and rebuilding family and community relationships and aims to keep young Indigenous people out of prison.
Balund-a offers a diversionary program for young Indigenous people on remand including cultural activities such as art and music.
Magistrates are able to sentence offenders to Balund-a after conviction or refer defendants to Balund-a as a condition of bail. The program also has the ability to accept offenders subject to
NCML on film
Left: Chair of the Northern NSW Local Health District, Hazel Bridgett, Mike Chapman, Jo Greggains, Grant McGifford and Vahid Saberi.
A Melbourne film crew visited northern NSW in late July to spend a day with North Coast Medicare Local’s CEO Vahid Saberi. The shoot was part of a promotional film organised by the Australian Medicare Local Alliance to explain the role and scope of Medicare Locals. It will be distributed widely - to the media, Medicare Local staff, politicians and the community. Director of the University Centre of Rural Health, Prof Lesley Barclay and the Chair of the Northern NSW Local Health District’s Board,
Hazel Bridgett also took part in the filming, explaining the relationships between their organisations and NCML and some current projects. Filming also took place at Balund-a, the Indigenous Youth Correctional Centre near Tabulam. The film will have its premiere at the official launch of Medicare Locals this month. Three Medicare Locals were chosen to be filmed – NCML, Western Sydney based in Blacktown and the Nepean Blue Mountains Medicare Local. View the video at: http://vimeo.com/47563382
community-based orders. Local Elders provide support and help residents to recognise, restore and value cultural links with their land and history. Balund-a also aims to develop
partnerships with community organisations in order to support resettlement, allowing continuing support after the resident leaves Balund-a. NCML’s CEO Vahid Saberi and branch manager Chris Clark; Dr Christine Ahearn from North Coast GP Training and Dr Andrew Binns from Gurgun Bulahnggelah Aboriginal Medical Service, met Balund-a Elders Chris and Annabel Walker; Acting Director Community Corrections Lismore Cluster, Noelene Lavender; senior staff and Corrective Service representatives. Some of the ideas discussed included looking at using GP registrars at Balund-a, bringing various allied health practitioners out on a monthly basis and the use of nurse practitioners. A further meeting was organised to talk more about the proposals.
Paediatric Surgery Open Forum Senior Consultant Paediatric Surgeon Dr Rajendra Kumar will be holding an open forum on Thursday October 18 in Lismore to showcase his specialist procedures and take questions from GPs and specialists. Dr Kumar wants to extend his Paediatric Surgical Outreach Clinics further up the coast. Currently he consults at Tamworth, Muswellbrook, Maitland and Coffs Harbour as well as the John Hunter Children’s Hospital. He specialises in Minimal
Flushed drugs danger Large quantities of illicit and prescription drugs are being flushed down toilets and they are starting to risk people’s health, a UniSA study has found. The authors have warned there is no policy on the safe disposal of drugs into treated wastewater, surface water, drinking water, or the air; yet the residual drugs are making their way back into innocent
Invasive Surgery for children including neonates in the Neonatal Intensive Care Unit and during his talk he will cover topics including common surgical conditions in children, gastroschisis, paediatric trauma and minimal invasive surgery. Dr Kumar’s forum – a free event including a meal – will be held at the 561 Alphadale Restaurant on October 18. Registration is essential. To register, email: email@example.com. gov.au
victims from the environment and human food chain. Researcher Dr Raktim Pal said as drug use increased, more drugs and their ingredients were being flushed in human waste, or down sinks into the environment via the illegal dumping of drug-lab chemicals. “Contamination by illicit drug residues at very low concentrations appears to be widespread in populated areas with potential risks for human health and the environment,” he added.
The Big Book of Ideas WE NEED YOU! Our Medicare Local aims to improve the health of the North Coast community. It will work to increase the resourcing of primary care, and to act as a ‘system redesigner’. We want to make sure that every person has the care team that they need to look after themselves and their family, and to make sure that this care is joined up.
they have the tools, teams, skills and resources they need to better look after their patients. Identify and fill gaps in services where they exist in parts of our region, or to improve access to care by disadvantaged groups Make sure that each patient experiences ‘connected care’ - that each person and their health providers feel part of an integrated care team.
We will need to: Support the primary care providers in the region so that
To achieve these aims, we need you. You are the experts in your
The Copernican Inversion Series (CIS) aims to bring together local clinicians, service providers and the university sector for a breakfast exchange to discuss innovations and ideas in local health. Copernicus was a 16th century Polish astronomer and mathematician who proposed that the Sun, not the Earth, was the centre of the Solar System, with the Earth revolving around the Sun. This theory turned not only human knowledge but the human psyche inside out, creating what is known as the Copernican Inversion. The term ‘inversion’ is now used to denote major leaps in knowledge, a progressive shift or change in perspective. North Coast Medicare Local is commencing The Inversion Series where we intend to bring together all those involved in healthcare delivery, the university
sector, researchers, volunteers and the community to network, share and link knowledge. The agenda will include those undertaking innovative work in various fields, such as primary healthcare practitioners, acute sector practitioners, non-government organisation clinicians and providers to present innovative work in a presentation of not more than 10 minutes followed by a conversation. The Inversion Series will be held over breakfast from 7.30 to 9am. It will be held two times a year (8 overall) at each of the following sites Tweed Heads, Lismore, Coffs Harbour and Port Macquarie. Please look out as you will soon receive an invitation to the first of The Inversion Series Breakfasts. We look forward to a dynamic exchange.
Tony Lembke Transition Chair of NCML
own towns. You know how to make the best of the resources you have available. You know what services your community needs. The ‘change ideas’ we need to improve care will come from you. We have set up a ‘Big Book of Ideas’, which we are looking to fill
up. We need to know what we can do so as to help you care for your patients, and we need to know what new services they need. If we are to meet our objectives in improving primary care, we will need to work together to develop new systems for primary care and we will need to find innovative solutions. I think that there are many exciting opportunities to improve health in our region, and we look forward to your contributions to our ‘Big Book of Ideas’. Send your ideas to: firstname.lastname@example.org
(Practical Ideas to Change Healthcare) The PITCH is an initiative of NCML Helix Program, which aims to encourage and nurture ideas to promote change.
Do you have an idea that could improve healthcare in our community? NCML invites you to PITCH your idea to us, and we will make it happen. We are looking for two-minute pitches, bright ideas for Connecting Healthcare. Make your two-minute PITCH in person or as a video clip. We will invest in the best idea and make it a reality. The PITCH presentation will be on October 17th 2012. The innovator of the winning PITCH will be supported to attend a conference or educational event of their choice within Australia. To make your PITCH, submit an expression of interest via www.ncml.org.au no later than 16 September 2012 If you have any questions, contact Sharyn White or Vahid Saberi on 6618 5400 or email: email@example.com
Collaboration supports youth mental health headspace Mid North Coast (hMNC) is an early intervention youth health service delivering high quality, culturally appropriate primary health, mental health and case management support to young people aged 12 to 25. hMNC is funded by the Australian Government Department of Health and Ageing under the Youth Mental Health Initiative Program via headspace National and administered by GenHealth.. One hundred youth practitioners have joined forces to discuss new and innovative ways to work together to support young people in need across the Mid North Coast. Under the banner of the Youth Mental Health and Wellbeing Network, formerly known as the Coffs Harbour Youth Suicide Prevention Committee, youth workers, doctors, psychologists, school counsellors, teachers, principals, council staff, etc converged on Toormina High School late in June to launch the rebranded Youth Mental Health and Wellbeing Network.
Jesse Taylor at the Coffs Harbour headspace.
Mental health expert, Professor Patrick McGorry AO spoke on issues impacting youth mental health and how we can collectively support our youth. “It’s great to be here with headspace Mid North Coast and the Youth Mental Health and Wellbeing Network. Together we’re helping young people to get their lives back on track,” said Prof McGorry. “Working together in community partnership with the Youth Mental Health and Wellbeing Network helps us support and
foster the development of our most precious resource, our young people. Together we are working to reduce the stigma associated with mental health, while encouraging help seeking early.” Toormina High School Principal, Liz Donnan, said. TAFE student Phenessa Rossiter believes this community initiative will achieve some important things. “It seems like everyone wants to lend a hand on the issue of youth mental health. As a young person, it’s a great opportunity to
After hours pilot projects By Sharyn White NCML’s Manager, Strategic Development and Program Design Earlier this year, North Coast Medicare Local (NCML) conducted a region-wide audit of general practices as well as other primary health care providers to ascertain the after hours services currently available. This information is being used to help NCML identify gaps in after hours services and help make the best decisions about how to make use of funding to fill these. NCML has had a stage one after hours plan approved and funded by the Department of Health and Ageing. This initial funding will allow Medicare Locals to address immediate service gaps and NCML has chosen to do this by running pilot projects in locations where there is no, or limited, existing after hours 6
GP service. The federal government has set clear program aims for the after hours program, but they have not been prescriptive about the allocation of after hours funding. This allows NCML to develop locally relevant funding models in a way that a one size fits all approach cannot. Funding needs to be distributed equitably, but not necessarily equally. The after hours survey identified 151 GP practices with 131 reporting providing some level of after hours service. NCML also identified 125 pharmacies and noted their opening hours. This is important information because after hours medical care is not useful if the hospital is the only place medicines can be accessed. Additionally, NCML conducted a region-wide needs assessment for after hours services and identified a number of communities with no reasonable access to after hours medical care. We are now
working to address these gaps. NCML is committed to finding local solutions to local challenges. The steering groups in these identified locations will have the flexibility to develop locally relevant strategies which will link into the healthdirect GP after hours helpline and could be supported by telemedicine links. We are excited that local teams have the opportunity to be innovative. We are hopeful that some of the pilots will
express my opinion to the people that locally set the youth mental health agenda,” she said. Dr Nicola Holmes and Dr Tim Francis of North Coast General Practice Training led a group of 12 GP registrars to the session to help inspire them to up-skill in youth health. The North Coast Medicare Local is proud to be a Steering Committee member for the Youth Mental Health and Wellbeing Network. The Network is working on a youth mental health professional development session featuring Professor Michael Carr-Gregg scheduled for this November, so watch this space. The Youth Mental Health and Wellbeing Network meets twice a term at headspace Mid North Coast in Coffs Harbour. A free lunch is provided at the meeting through the generous support of the Mental Health Professionals Network. To get involved, to visit headspaceor for more information, contact manager Jesse Taylor at: firstname.lastname@example.org or phone 0488 180 365.
result in approaches that can be implemented in other locations, alleviating pressure on GPs and small hospitals. Another crucial component of our work during 2012/ 2013 will be to work with local GPs to develop an equitable way to fund after hours services once the Practice Incentive Payments Program changes are introduced next year. This work is just beginning. But we are committed to ensuring continued access to face to face medical services in the after hours period and understand that practices will need to be supported to provide this service. Changes to the PIP incentives don’t occur until July 2013. NCML will ensure contracts are put in place once we have consulted with our GPs and better understand the levers and barriers to the provision of this service. It is an important piece of work and needs to be done carefully. This will take some time and HealthSpeak will keep you up to date with this process. HealthSpeak
Palliative Care – Next Steps A Palliative Care Workshop held in Yamba in May was the important starting point for North Coast Medicare Local (NCML) to encourage collaboration and improve the palliative care journey for North Coast patients and their families. The workshop was jointly sponsored by the Federal Member for Page Janelle Saffin and NCML and around 70 participants attended the day-long gathering. It was the first time such a meeting had been held and participants included volunteers, clients, carers, clinicians, community health, allied health, RACF, hospitals and specialists. Overall the mood of those present was optimistic, with a will to work together to improve the provision of palliative care. In late July the first meeting of the North Coast Palliative Care Steering Committee took place and some of the actions planned arising from the Yamba workshop
include the following: Establishing a Tweed, Richmond, Clarence Palliative Care Forum Establishing steering and reference groups Continuing to build skills and confidence in GP teams in order to be clinical leads in multidisciplinary/multiagency care Identifying needs and working collaboratively to establish professional development for general practice and others in palliative care Educating families, carers and NGOs. Devising ongoing methods of education for non-clinicians Providing greater specialist advice to residential aged care facilities (RACFs) Educating nurses in RACFs (about palliative care and Advance Care Directives,
such as MyChoice – a comprehensive manual on Advance Care Directives developed by Northern Rivers GP Network. Improved information flow between clinicians and agencies and prioritising Patient Controlled Electronic Health Records for Palliative Care Providers Use of Telehealth to increase efficiency of consultation role of specialist palliative care staff. Applying for Commonwealth Grant funding The first meeting of the Palliative Care Steering Group will be held soon and a second Palliative Care Forum is scheduled for November. A similar structure will be established in the southern part of the NCML footprint. Anyone wishing to add their name to the Palliative Care mailing list, should email: email@example.com
National Services Directory Medicare Locals have played a big role in developing the National Health Services Directory, now available online. This resource is the first truly national directory of General Practice, Pharmacy, Hospital and Emergency Department services - with contact details and opening hours. The Directory is on the internet (www.nhsd. com.au) and available for mobile access (m.nhsd. com.au). The Directory will be expanded to include much more primary care and allied health information, greater detail within services listings, an Endpoint Location Service (to help with secure clinical messaging) and the inclusion of telehealth and child wellness information.
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02 6681 9900 7
Access to Allied Psychological Services (ATAPS) With HealthSpeak’s broader audience, it’s timely to explain ATAPS and the various mental health services offered under ATAPS by North Coast Medicare Local’s four branches.
Coffs Harbour, Nambucca, Urunga and Bowraville. Psychiatrist Peter O’Brien works at Galanbilla Aboriginal Medical Service and also sees patients at a Grafton clinic,assisted by mental health nurse Scott Hanson.
What is ATAPS?
ATAPS is a pathway which enables GPs across the NCML region to refer disadvantaged or hard to reach patients to mental health professionals for focussed psychological strategies. ATAPS practitioners include psychologists, social workers, mental health nurses and occupational therapists.
Access to ATAPS
Eligible patients come under two groups. Tier One: General ATAPS referral Individuals for whom Medicare-based services are not affordable or appropriate ‘Hard to reach’ groups including youth, Indigenous Australians, people from culturally diverse backgrounds Tier Two: Target groups for whom funding is more flexible Women with perinatal depression Children 12 years and under Individuals who have attempted suicide or self harm or are at high risk Individuals who are homeless or at risk of homelessness
What services can be provided?
In Tier One, treatment may include a range of therapies and personal skills development. Treatment will generally be determined in response to diagnosis and preparation of a GP Mental Health Treatment Plan by the GP with subsequent assessment by the allied health professional. In Tier Two, delivery options include CBT, behavioural therapy, parent training in behaviour management, liaison with schools, liaising with local NGOs 8
ATAPS enables GPs to refer disadvantaged patients to mental health professionals for timely care.
to support homeless individuals.
NCML runs the Tarmons House Mental Health Service in Lismore through a combination of funding sources including ATAPS. Clinicians – psychologists and social workers - also provide outreach services at Casino and Ballina. Tarmons House Mental Health Service provides shortterm psychological intervention and accepts referrals from GPs practising in the Northern Rivers region for clients with a Mental Health Treatment Plan. Treatment offered includes face to face psychological therapy, telephone Cognitive Behavioural Therapy, help for new mums with perinatal depression and Aboriginal and Torres Strait Islander Mental Health Services. Recently, Tarmons instituted an Indigenous Suicide Prevention Service which is open to people at moderate risk of suicide and/ or self-harm. Criteria for entry to the service include expression of suicidal intent to GP or presentation to a GP after self-harm. If assessment indicates the patient is at high risk of suicide then they are referred to the Acute Care Team and the outcome reported to the GP. At the end of the intervention, recommendations will be made to either manage the patient within primary care practice or refer them for further treatment of their issues. For more information, contact
Tarmons’ Practice Manager Vickie Williams on 6621 7319.
GP referrals are made through Tarmons House in Lismore. Patients are then directed to clinicians in the Tweed area. A Suicide Prevention Service is being run in conjunction with the Northern NSW Local Health District. For more information, phone 6621 7319.
Mid North Coast
Tier one: Psychologists employed by NCML work out of Grafton,
Tier two: Aboriginal and Torres Strait Islander mental health service providers employed by NCML work out of Galanbilla Aboriginal Medical Service in Coffs Harbour and perinatal depression treatment is offered at Coffs Harbour and Grafton. Child mental health services are currently being put in place and will soon be available at Grafton, Coffs Harbour and Bellingen. For more information, contact Amy Crowe on 6651 5774.
Psychologist Sue Baugham is employed by NCML through ATAPS funding and there are an additional three psychologists providing sessional services through ATAPS Tier one in this region. Ruth Nolan, creative arts therapist, provides Tier 2 trauma, grief, and loss group sessions to Aboriginal women in the Macleay Valley. For more information phone 6583 3600.
Kids and Pets
It seems worrying about dog and cat licks and germs is a thing of the past with new evidence on the effects. A Finnish study has found that dog and cat contacts may have a protective effect on respiratory tract infections during the first year of life and possibly lead to better resistance to respiratory illnesses during childhood. In this birth cohort study 397 children were followed up from pregnancy onward and information gathered about frequency of respiratory symptoms and dog and cat contacts during the first year
of life reported using diaries and a questionnaire. In multivariate analysis, children with dogs at home were healthier – fewer respiratory tract symptoms or infections – than those with no dog or cat contacts. Additionally, children with dog contacts had less frequent otitis media and tended to need fewer courses of antibiotics. (Paediatrics, published online July 9, 2012).
NCML’s Award winning staff dermatology conference, through the Australian Dermatology Nurses Association. Ultra Violet B phototherapy is particularly helpful for patients suffering from the disfiguring skin condition psoriasis as the UVB rays penetrate the skin and slow the growth of affected skin cells. Cath trained as an enrolled nurse at Coffs Harbour Base Hospital and worked there for 20 years in between raising four children and also looking after
the running of a small business. Cath really enjoys her work as she gets to provide ongoing support and care to her patients as they journey through their treatments. “I see them bloom in confidence as their skin improves. One woman told me she hadn’t worn a skirt in 30 years because of her psoriasis and the first thing she was doing after finishing treatment was to buy a new one. Another woman told me that I’d saved her marriage,” she said.
From left, Louise from GSK, Irina Holmes, Practice Nurse, Giingan Durrunday Marlaanggu Health Clinic, Dr Niall Hearndren, Chair of GSK Childhood Immunisation Awards and Leigh Eastwood.
Recently two North Coast Medicare Local (NCML) staff members were recognised by external organisations for their exceptional service and commitment to health care. Coffs Harbour’s Immunisation Project Officer Leigh Eastwood and her team – Irina Holmes, Practice Nurse and Jeannette Chapman, Child and Family Nurse, who both worked at Giingan DurrundayMarlaanggu Health Clinic at Bowraville and Darrimba Maarra Aboriginal Medical Clinic at Nambucca; along with John Turahui, Immunisation Coordinator at NSW Health in Port Macquarie won a Child Immunisation Award from GSK worth $15,000. NCML identified that childhood immunisation rates at two Aboriginal medical clinics in the Nambucca Valley were 57.4%, markedly lower than other general practices in the local government area. To close this gap staff implemented new data collection, recall and reminder processes and actively promoted the benefits of childhood immunisation to the community. To increase public awareness Leigh Eastwood also developed a competition involving 12 swim schools with swimming lessons as prizes. This was supported by a local Aboriginal swimmer Djaran Smith, and promoted at preschools, childcare centres and general practices. As a direct HealthSpeak
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Cath Bird helps a UVB patient.
result, NCML increased participation in immunisation programs across the two Aboriginal medical clinics to 92.5 and 100 per cent, exceeding initial targets and dramatically improving health care across the community. “This is a great example of the improvements that can be achieved by a collaborative approach, dedicated staff and great teamwork. It is great that GSK has initiated these awards for Immunisation providers to strive for improvements,” said Leigh. NCML aims to reinvest the $15,000 prize money to continue to improve immunisation programs in the local area. Another Coffs Harbour NCML staff member – UVB phototherapy nurse Cath Bird was also recognised recently for her exceptional commitment to her patients. She was this year’s winner of the Bernadette Meyer Travel Award to attend a national
With publication and production costs rising, we are also producing HealthSpeak in a reader friendly digital format, which can be sent directly to your email box. If you’d like to help us keep costs down and would be happy to receive your magazine electronically, please let us know. Simply email: firstname.lastname@example.org HealthSpeak is also the perfect place to advertise your health service, practice, guesthouse, restaurant or tourist venture. With a footprint from the Queensland border to south of Port Macquarie, and reaching around 6000 health professionals, students, academics and the wider community, it’s a terrific opportunity to get your advertising message out to this discerning audience HealthSpeak is published every three months and attractive display and classified advertising rates are available. Simply phone Janet on 6622 4453 or email: email@example.com
Collaborations in learning By Sandi Hill Collaboratives Program Manager The Collaboratives Program began its life at the Institute for Health Care Improvement (IHI) in the USA in 1995. This model for collaborative learning is designed to help organisations close the gap by creating a structure in which organisations can learn from each other and from recognised experts in areas where they want to make improvements. Since this beginning, hundreds of collaborative initiatives have sprung up with phenomenal results. When the Collaborative came to Australia in 2005, Northern Rivers General Practice Network was one of the pioneer divisions to enrol in the program. The Primary Care Collaborative waves were about learning how to deliver sustainable rapid systems change. Change that is do-able, and incremental, encouraging ‘whole of practice’ involvement. It aimed to help general practices and health professionals to work together to improve patients’ clinical outcomes, reduce lifestyle risk factors, and maintain good health for people with chronic disease and complex conditions. What was new about the Collaboratives Program was that it delivered the model through a
SLEEP CLINDIC AYS OPEN
series of learning workshops, informal ‘ideas factory’ meetings. Its communications were interspersed with activity periods during which measures common to the participating practices were used to track progress and support provided by the Collaboratives Program Manager. The program involved a supportive team based approach to quality improvement, encouraging sharing of ideas and innovations within practices and between other practices.The Collaboratives experience has been instrumental in helping general practices learn to cope with the changing face of primary health care. Achievements include the following:
Giant strides forward in clinical and business information systems management; improved use of medical software and regular maintenance of records to ensure ‘clean databases’.
Proactive Management of chronic disease
Better chronic disease management fostered through implementing proactive and regular recall systems and ensuring that a staff member is allocated the task of maintaining these systems as well as promoting patient self
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Award winning practice. In 2011 Tintenbar Medical Centre was recognized for its outstanding results in the Primary Care Collaboratives Program. A photo of the Tintenbar Medical Centre staff with, at left, Colin Frick, Chief Operating Officer of The Improvement Foundation and at right, NCML’s Sandi Hill.
management and health literacy.
Shared care models
Adoption of a shared care model with increased involvement of practice nurses as case managers in chronic disease and lifestyle risk factor management as well as prevention. Embracing a team approach has given better patient outcomes.
Use of EPC item numbers
Increased uptake of EPC item numbers, TCAs and health assessments, and increased involvement of allied health professionals in systematic team care has resulted, and enhanced interaction with other providers.
Culture of sharing ideas
Practices involved in the collaboratives no longer feel isolated and seek advice from each other. GPs, nurses and staff share ideas and perspectives. In the past year allied health professionals have begun attending meetings. When in 2009 we commenced bimonthly meetings to continue the culture of networking and sharing, the team selected a name. It became the Kaizen team.
So what’s Kaizen?
Kaizen is a Japanese word synonymous with continuous quality improvement by making small
changes, one step at a time! A few little kaizens here, a few graceful corrections there and shift happens!
E Health readiness
Fifty five general practices and aboriginal medical services in the NCML area from Port Macquarie to Tweed Heads, are currently involved in the Medicare Local National Wave and using proven collaborative methods. Our current focus is preparing for eHealth by ensuring data quality and accuracy in preparation for Electronic Health Records, undertaking foundation work such as registering for Health Care Identifiers and talking to patients about the PCEHR. Highly successful workshops were held in Lismore and Coffs Harbour on 26 & 27 June for participants of this wave.
Kaizen meetings have proven very successful at linking general practices, and North Coast NSW Medicare Local plans to use this proven method to link its wider target group of health care providers. We are also investigating the use of multimedia techniques to enhance communication. We have learned that by working together we can make a difference to patient outcomes in primary care.
GP training continues to grow on the North Coast Ballina-based North Coast GP Training (NCGPT) is one of the six founding members of North Coast Medicare Local (NCML) and shares the same boundaries, stretching from Port Macquarie to the Queensland border. NCGPT is the local Commonwealth funded organisation responsible for delivering the Australian General Practice Training program (AGPT) and the Prevocational GP Placements program. Through these programs, NCGPT recruits and oversees the training of GP registrars and junior doctors and organises their placements in accredited general practices throughout the North Coast. In 2011, NCGPT reached a milestone that would have seemed pretty near impossible just a few years ago. The number of GP registrars enrolled to train with the organisation hit the 100 mark. This year, registrar numbers increased again to 120. That’s 120 new doctors working, living and training in our region and providing much needed services. In January 2013 NCGPT will welcome a further 45 registrars to the AGPT program – a 100% increase in allocated AGPT training places over the past four years. To help NCGPT train these new doctors, the number of
The latest group of PGPPP doctors, Dr Anne Trang, Dr Andrew Martin and Dr Clare Collins with NCGPT Medical Educators.
accredited training practices has risen during the last two years from 45 to 50 and the ranks of accredited supervisors have swelled from 90 t0 120. Importantly, the growth wasn’t contained to the AGPT Program but also occurred in the Prevocational GP Placements Program (PGPPP). The PGPPP is relatively new to NSW but has been running successfully in other states for many years. PGPPP aims to provide hospital based junior doctors with well supervised and educational general practice rotations
Youth keen to learn about health careers
NCML took part in this year’s Coffs Coast Careers Expo for local youth. This annual event showcases and promotes a wide range of job opportunities and career pathways for local youth. Here school students are finding out more about health careers with the police force.
as part of their hospital training. Apart from being a strong recruitment tool, the program also aims to give junior doctors greater exposure to general practice and a better understanding of the integration between primary and secondary health care. After a successful start in 2010, NCGPT aims to have up to 50 PGPPP doctors completing 10-week posts in local practices. In addition to the AGPT and PGPPP programs, with funding provided by the NSW Rural Doctors Network, NCGPT supports over 30 overseas trained doctors working in our region to prepare for their College Fellowship exams. NCGPT also administers the NSW Rural GP Procedural Training program that provides GPs and registrars the opportunity to gain valuable procedural skills in Obstetrics, Anaesthetics, Emergency Medicine, Mental Health and Surgery. In 2013 NCGPT will work with the local health districts to support the implementation of the NSW Rural Generalist Program. This will offer GP registrars a structured career path to gain skills and training in Obstetrics and Anaesthetics in tandem with their general practice training. To complement its growth in GP training, NCGPT has increased its focus on medi-
cal education research, recently applying for grants and receiving funding to pursue two research projects investigating the use and effectiveness of vertical integrated models of medical education. A Research Director has been appointed to manage these projects and develop and direct the research capacity within the organisation. So what’s driving all this growth? John Langill, CEO of NCGPT, believes there are a number of factors. “The primary ones are the Government’s commitment to increasing the number of GPs for our communities, coupled with NCGPT’s ability to rapidly expand programs and importantly, continue to attract high quality candidates to fill our training places.” He also believes that increasing training places nationally is only half the story. “The real story behind NCGPT’s rapid growth is a much more local one. It’s about the strong partnerships that NCGPT has formed across the region and the commitment and dedication of the 120 supervisors and all the practice managers who make sure that our registrars and PGPPP doctors are well supported throughout their training programs. It’s also about the strength of the education program our medical education team delivers and how they continuously look for ways to improve it.” What pleases John the most are the doctors choosing to join the NCGPT programs. “The overwhelming majority of our doctors are those who want to live and work in our region. Not because they have to, but because they want to. They are the kind of doctors who are enthusiastic learners and are going to make exceptional GPs. “Having all the regional GP networks working together under NCML means there will be greater communication and cooperation between all primary health care organisations. NCGPT looks forward to working with and supporting the Medicare Local over the coming months and years,” he added.
Are we there yet? NCML Chair Tony Lembke reflects on the launch road trip. A 450km drive from Tweed Heads to Port Macquarie and that nagging question ‘are we there yet?’ kept coming to mind. En route we stopped for: four ‘Round Tables’ with local health and community leaders; had two town hall meetings for health providers and interested members of the public; we told ABC local radio about our community consultations; and we met with the three Federal MPs and two state members, local councillors and a mayor. This road trip had us navigating a course never experienced before by local communities – a local organisation actively working to deliver comprehensive primary health care. It’s new territory for many. At each meeting, when people were vague about how it would all work, we described the patient-centred health system and the medical home, drawing on the ‘map’ that we developed. It was remarkably effective. It answered many peoples’ concerns and made it clearer what we could do and where we would act. Everyone wants a medical home for their family, and providers want to be part of an Integrated Care Team as outlined in the model. People came with burning issues, seeking solutions and wanting an advocate. By the end they were excited. They could see that this Medicare Local will listen and help. We heard lots of new ideas
NCML is truly local, operated by local clinicians and the community, not a branch of Sydney or Canberra about how to improve health. There was enthusiasm from all the groups and you could see the ideas and possibilities ticking over in their minds (as no doubt they could see in ours) and we now have lots of new partners that we hadn’t expected. Governance, board and membership issues were not an issue. The interest was in what this ML will do for them and clearly building community will be an important role for us. We learnt early on to ask the question: how does the community want to participate and influence? It gave them a sense of ownership of the ML – which is exactly correct. The NCML is truly ‘local’ – it is operated by local clinicians and the local community, and accountable to the local community. It is not a branch of Sydney or Canberra. In explaining this we emphasise that our greatest challenge is to build better systems for the delivery of better care. That is our job.
We will operate in three main ways: Create people-focussed care – everyone deserves timely and accessible care. This means that where there are ‘gaps’ we will either advocate for new services or provide them ourselves. Connect the care - improving peoples’ experience of care, including that of clinicians Improve the quality – by working with local primary care providers to improve the quality and capacity of services It is clearer to me that we are the primary care umbrella and that this role has been a gap needing to be filled for a long time. Medicare Locals are unique in their local ambitions. About the closest organisational structure you can get to MLs is the ABC – delivers nationally and locally. This trip clarified for me that although GPs are absolutely central to the work the ML will do, it does not and cannot belong to them. If it is to be an effective organisation, the 300,000 locals need to ‘own’ the ML. As it turns out, that is a much more exciting opportunity. Are we there yet? No, but fortunately the maps are getting easier to read and as for the journey, it should never end. Read all about the launch events starting on page 15.
Have a B rea
e-mental health portal launched A new portal, mindhealthconnect provides consumers with a trustworthy source of information and support and a gateway to therapy for people seeking help for mental health disorders. Minister for Mental Health Mark Butler said the launch of the site delivered one of the key objectives of the Government's new e-Mental Health Strategy.
“This portal will allow people to access information and treatment as an alternative to traditional face-to face services, in their own time, in an environment in which they’re
comfortable,” Mr Butler said. “mindhealthconnect provides Australians with a pathway to trusted online therapy services and crisis support services as well as information on high
prevalence conditions such as depression and anxiety. “Evidence backs the use of online and telephone services to assist those suffering mild to moderate mental disorders and distress, and it can also help combat barriers to conventional therapy.” Go to: www.mindhealthconnect.org.au
The Koori Grapevine Deadly living the way to go By Jess McCormack NCML staff member and dietitian at Bugalwena General Practice
Getting smiles and great results – Deadly Living - an Indigenous Healthy Lifestyle group at Tweed Heads is working up a sweat! Deadly meaning “good” Living is a weekly group that started over 18 months ago in South Tweed and continues on a weekly basis. Deadly Living was initiated due to the lack of Indigenous people attending main stream rehab programs, and has since evolved into a general healthy lifestyle program. Deadly Living runs each Wednesday at “Stingrays” –Tweed Aboriginal Corporation of Sport, and is aimed at anyone with an existing chronic disease or those
Shane Oldfield and Lyndon Combo in the ring, demonstrating Deadly Living.
who are at risk of a chronic disease. The group is run by Jaime Close, Bugalwena General Practice’s resident Exercise Physiologist and is attended weekly by Beck Palmer, Aboriginal Health Worker and Jess McCormack, Dietitian. The sessions entail an hour of
Tweed Valley celebrates NAIDOC Week
exercise/activity for all levels of fitness and mobility from walks, boxing, getting some exercise on bikes, weights and balance activities, followed by morning tea and a yarn. Topics covered include food and eating, healthy cooking and shopping, medications, making daily activities easier, benefits
of exercise, general health and well being, smoking and breathing and a general yarn and catch up. Potential Deadly Livers are asked to obtain an exercise clearance from their regular GP before coming along. The program continues to be evaluated. Already some participants have seen a reduction in weight, waist circumference, blood pressure, HbA1c and an increase in walking times or fitness levels. Anecdotal observations include one participant who now rides his bike to the group, other participants attend the gym on days other than the designated Deadly Living time and all reported positive feedback and found the social interaction beneficial! For more information call Jess at Bugalwena General Practice on (07) 5513 1322.
naidoc week Coffs Harbour
From left, NCML’s Corinne Martin, Aboriginal and Torres Strait Islander Health Project Officer, Dietitian Jess McCormack and Chris Edser, Practice Nurse at Bugalwena General Practice at the NCML stall in Arkinstall Park.
North Coast Medicare Local’s Tweed branch launched a new range of resources for the Indigenous community during NAIDOC week. A series of colourful posters, information postcards and stickers were designed using local Aboriginal artworks secured by running a local art competition in late 2010. The quality of entries was so high that a number of prizes were awarded and the winning artworks have been used to highlight various health messages including immunisation, healthy body/ healthy mind, smoking,
drug and alcohol, identifying and to promote the Indigenous health incentive program. The Indigenous community and Indigenous service providers were consulted to ensure cultural appropriateness of all messages and information. The junior winner’s artwork also features on a bag which was filled with health information and handed out during NAIDOC week to schools, local organisations and community members at the NAIDOC health and sports day at Arkinstall Park. The health day provided free health checks to the community including ear checks for children, blood pressure, blood sugar levels and a smokalyzer to measure the levels of toxic carbon monoxide inhaled from tobacco smoke by smokers.
Terry Donovan, Aboriginal Outreach Worker, Sumah Lee, CTG Project Officer and Gloria Little, Indigenous Health Program Officer at the NAIDOC stall.
By Sumah Lee The Closing the Gap team from NCML Coffs Harbour participated in the "Who Ya Gonna Call?" forum held during NAIDOC week and organised by the Aboriginal Health Team from the Coffs Harbour Health Campus. The forum was held to promote services to the Aboriginal Community within the Coffs Harbour area and more than 52 stalls showcased a wide
range of services. The Closing the Gap team attended to promote the Make Every Day a 'Deadly' Day Tshirts and the 715 Indigenous Health brochures. T-Shirts were given to participants after they named at least three chronic diseases and they were then given information about the 715 Indigenous Health Check. The event provided great networking opportunities and community involvement for the Closing the Gap team.
The Koori Grapevine
Introducing Move 2 Change
New Indigenous Suicide Prevention Service
Christine Kennedy-Copeland on graduation day with Lismore Mayor Jenny Dowell. Tarmons House offers a new Indigenous Suicide Prevention Program.
North Coast Medicare Local (NCML) is in the process of setting up an Indigenous Suicide Prevention Service, which will operate out of the three Aboriginal Medical Services in the Northern Rivers – Bullinah at Ballina, Gurgun Bulahnggelah in Lismore and Dharah Gibinj Aboriginal Medical Service in Casino. The service provides rapid access psychological assessment and intervention for people at mild to moderate risk of suicide and/or self-harm. NCML’s Mental Health Service Practice Manager Vickie Williams has sent all GPs in the area a flow chart to help them streamline the referral process to this important new service. “The referral process is clearly outlined and importantly, the clinicians who will be working with these patients will be trained in Indigenous cultural awareness,”
said Vickie. The Suicide Prevention Service is an additional service to those that NCML offers to Indigenous clients at Tarmons House in Lismore. “It’s especially designed to serve people at risk of suicide and selfharm. Clients who are in great distress can have additional appointments throughout the week and a telephone follow-up service is available,” Vickie said. All patients of the Suicide Prevention Suicide will be provided with the contact details of the After Hours Crisis Support Line. At the end of the intervention, recommendations will be made to their GP and either managed within primary care, or referred for further treatment once a Mental Health Care Plan has been developed. GP referrals can be faxed to 6622 7082.
Eight newly qualified Indigenous personal trainers are running classes in the Move 2 Change healthy lifestyle program for adults living in the Lismore Local Government Area. Funded through a Federal Government Healthy Communities grant, the new graduates will provide support for people on their journey to better health. Every adult who joins Move2Change receives a free health assessment before getting started and an individually-tailored program. One of the real attractions of Move2Change is that classes are low cost – a gold coin donation for anyone who is unemployed; Aboriginal or Torres Strait Islander; from a non-English speaking background; over 55; a refugee; living with a disability; or a carer. Classes offered include Heartmoves, for those with
heart disease, diabetes and other related conditions; FOODcents, a nutrition and lifestyle education program that includes modules on shopping, budgeting and cooking and Beat It, a 10-week physical activity and lifestyle education program designed by the Australian Diabetes Council. Christine KennedyCopeland is one of the newly qualified personal trainers and told HealthSpeak she absolutely loves running the Beat It classes. “I work with all ages and cultures and people with disabilities. It’s great fun and satisfying to see people getting fitter and interested in a healthier lifestyle,” she said. Move 2 Change is offered through Lismore City Council. Phone Tarryn Corlet for more information on 1300 87 83 87.
Otitis Media in the Northern Rivers Otitis media (middle ear infection) is the focus of a new in Indigenous Health program for the Northern Rivers. The Otitis Media Guidelines Program aims to help general practices implement the 2010 updated Recommendations for Clinical Care Guidelines on the Management of Otitis Media in Aboriginal and Torres Strait Islander Populations (“the Guidelines”). The program also aims to increase local awareness of otitis media and improve collaboration between 14
those working locally to target the condition. One of the first steps towards this was an Otitis Media Education and Training Workshop held at Tarmons House in Lismore in late July. This workshop brought together representatives from mainstream general practices, Aboriginal Health and Medical Services (AHS & AMSs) and Community Health Services, all keen to improve their knowledge on the diagnosis, treatment and management of otitis media, as
well as develop and foster relationships between services. The overall success of the day assisted
in building a strong foundation for this program, which will continue to strengthen over the months to come. If you have any questions concerning the Otitis Media Guidelines Program, the Guidelines themselves, or are interested in learning more about the Otitis Media Education and Training Workshop please contact Jess Fernance, Indigenous Health Project Officer at NCML Northern Rivers Branch Office on (02) 6622 4453.
Community turns out for NCML launch events academics. The media supported the launch of NCML by placing brief articles and community service announcements about our public meetings in newspapers, on radio and television and we were pleased at the number of people who came to public meetings. It was interesting to note that at every meeting people wanted to stay back and talk more about NCML – a sure sign of community interest. NCML is organising a gathering of interested people
who attended the public launch meetings to further discuss particular health care issues. Below is a brief summary of the meetings and the particular concerns raised.
We are pleased with the enthusiastic response from the community to NCML.
Ballina A VIP Roundtable event and a public meeting were held in Ballina at the RSL Club. The main discussion topics were: How to best support efficient primary health care, especially in the face of an ageing population Better coordinated care needed - good health starts in the home, not the hospital. Need to improve the patient experience and focus on
practical issues such as transport Better connected primary health care State-government funding of primary health care Proposal that NCML manages the ‘grey zone’ between state and federal funding Lack of connectivity between hospital and general practice/specialists/allied health Promote choice for patients, including indigenous people. General practice to be a gateway, not a gatekeeper.
Dan Ewald addresses the Balliina Roundtable meeting.
Casino Finding a fulltime GP for Bonalbo and boosting its hospital services were the main topics of the night at the meeting at Casino RSM Club. A pharmacist also wanted to know how best he could get involved with NCML. This was a small meeting as Bonalbo was the main topic at Casino. a few weeks earlier a well-attended gathering of health professionals and community members was held in Casino.
NCML’s Michael Carter, Chris Clark and Peter Gibson.
Community members were keen to hear about NCML.
During the month of June, North Coast Medicare Local’s CEO, Vahid Saberi, NCML’s Chair Dr Tony Lembke, Board members Dr David Gregory, Dr Peter Ackerley, Dr Ray Jones, Dr Di Blanckensee; Dr Dan Ewald and Dr Helena Johnstone took part in presenta-
tions to both VIP events and public meetings, introducing North Coast Medicare Local (NCML) to the community and talking about its role and aims. While each location had its own particular flavour, depending upon the venue and those attending and the local issues, overwhelmingly these 14 meetings involved a positive exchange of ideas. The roundtable presentations met with an enthusiastic response from politicians, area health and hospital representatives, clinicians and
Clinicians and community members hear from NCML’s CEO.
In Coffs Harbour NCML held a VIP Roundtable event and a public meeting at the C ex Coffs Club. Discussion topics included: Importance of disease prevention programs After hours GP funding –
how is it to be prioritised? Parkinson’s patients need to be treated within the community Clarity about how to determine health care gap priorities How NCML will collect and use data
General Manager Sandhya Fernandez with Vahid Saberi.
Need for functions such as wound care to be managed in the community Transport barriers NCML’s role in workforce recruitment and retention The GP After Hours Helpline How general practice
needs are determined Better coordination needed between practitioners and hospitals Lack of home care services for nutrition and post natal depression How pharmacists collaborate and work with NCML
Grafton A public meeting at Grafton Services Club was well attended with many concerns and several heartfelt personal stories about the lack of mental health beds in the area. Topics discussed: Inability for mental health patients to be admitted overnight Upskilling of staff to
handle mental health patients in ED departments Need for short stay beds for mental health patients Not enough promotion of existing services Indigenous patients can’t access services Limited healthy lifestyle activities and promotion of these Mental health beds were an issue of concern at Grafton.
NCML Chair Tony Lembke explained the role of NCML.
The community stayed around to talk after the meeting.
How does one become a partner of NCML?
Importance of local solutions to local problems Kempsey residents have limited access to services The availability of e-health records to practitioners
Kempsey RSL was the venue for NCML’s public meeting here. Main discussion points:
Lismore Kempsey residents have limited access to health services.
Nambucca This public meeting at Nambucca RSL saw a variety of issues discussed: Lack of dialysis services at Macksville Hospital – travel time and cost problems for renal patients Aged care sector – challenges faced by
limited access to GPs and insufficient home-based services Inadequate or nonexistent hospital discharge summaries Lack of transport in remote areas means patient burden on hospitals.
Participants at Lismore’s Roundtable meeting.
NCML staff Vickie Williams and Anne McLean with (at left) Kylie Connolly , Care Manager at Caroona-Jarman aged care in Goonellabah.
Lack of transport was raised in the discussion at Nambucca.
Here a VIP Roundtable event and a public meeting were held. Despite clashing with the State of Origin football match, there was a good community turnout at the public meeting. There was much discussion about health promotion and the social determinants of health. Topics included:
Dr Helena Johnstone, Andrew Bailey and Jenny Zinkler from Nambucca Care with CEO Vahid Saberi.
What are NCML’s Key Performance Indicators? Issue of privacy with ehealth rollout Need to focus on preventative health measures How do Super Clinics fit in with Medicare Locals? Where does health promotion sit in NCML?
Will NCML help the Australian Dental Association advocate? Mapping required of who gets which services and where from Questions about NCML’s scope – will we be looking at underage drinking in Byron Bay or health effects of CSG mining? How can allied health practitioners get involved Desire to meet other practitioners in mixed groups – not just all physios for example Will general practice continue to get support from NCML? How can NGOs get involved?
Port Macquarie A public meeting and a VIP Roundtable event were held at Port Panthers. Main points of discussion: Allied health workforce shortages and training opportunities Working with NCML as partners and organisational members Will community health
Tweed Valley transfer to NCML? How will after hours funding be used? Will after hours include other services such as palliative care? Are dental services part of NCML’s scope? Are e-health records to be opened up to other disciplines?
Two events were held at Tweed Heads Twin Towns Services Club – a public meeting and a VIP Roundtable event. Issues discussed: Challenges posed by NSW/Qld cross border issues Hearing the consumer voices and engaging with not for profit sector and NGOs. Issues related to implementation of e-health records Schools provide an opportunity for promoting good health NCML interaction with NOROC NCML’s involvement in health workforce training Does current funding structure facilitate good
patient care Important to focus on preventative care and community aged care Working with state-based services Promotion of services and how to access them Need for direct access to allied health, not always through a GP Services inadequate for people with complex needs Hospital/general practice/allied health communication needs to be improved Important to break down barriers between professions and connect care NCML’s involvement in research and development
NCML staff & Board member David Gregory after the meeting.
NCML CEO Vahis Saberi addresses a Port Macquarie meeting.
NCML’s Chief Executive Officer Vahid Saberi told the launch meetings that research and experience showed that in order to keep the community healthy and improve health outcomes, it was necessary to shift the focus to primary health care provided in the community (out of hospital care). This, he said, was the focus of North Coast Medicare Local.
Much of the care done previously in hospitals could be provided effectively in the community by multidisciplinary teams working in collaboration and unison. 18
Tweed NCML Manager Gary Southey with VIPs.
VIPs and NCML Board members and staff at the Roundtable.
Arts Health and Wellbeing Unique program for Aboriginal women With some innovative thinking, North Coast Medicare Local (NCML) managed to secure ATAPS funding this year for counsellor and Creative Arts Therapist Ruth Nolan to run Gudhur Galban, a creative arts therapy course for Aboriginal women in the Kempsey area. NCML Hasting Macleay’s Program Manager Bob Boss-Walker said this valuable program came about because NCML’s employed psychologist Sue Baughman was directly involved with Ruth during the running of a 2011 pilot program. The exceptional skills Ruth demonstrated in the group, which resulted in major transformational shifts in the wellbeing of the participants, enabled NCML to obtain funding for Ruth to run her own program. Ruth Nolan has a wealth of experience in the community sector in diverse contexts including NGOs, community homes, TAFE and as a domestic violence court advocate. She told HealthSpeak about the value of the creative arts therapy techniques she uses to improve the health and wellbeing of the women in her program. “Creative arts processes enhance engagement, self-expression, community, wellbeing, self-esteem, emotional intelligence, integration, stress relief, collaboration and change. They are gentle, life affirming and transformative, allowing expression in realms where words fail,” said Ruth. She explained that Creative Arts Therapy is different from Art Therapy in that it is not used in a diagnostic and analytical way as Art
An installation created during one of Ruth's recent Creative Arts Therapy workshop.
Therapy can be. It uses modes of expression including movement, sound, mime, dance, poetry and writing. “It’s a participatory process involving both the therapist and client. The work allows feelings to become embodied and focusses on the present moment,” Ruth said. Creative Arts Therapy is very useful for working with trauma or loss or shock, helping by reconnecting people to their senses using physical means integrated with dialogue. “The process makes a link between what is there, feeling what it is all about and cognition, bringing the somatic into the cognitive.” As well as working with elders of the Kempsey Aboriginal women’s community, Ruth has used her training in other spheres, such as working with victims of domestic
violence. “It’s very gentle work, I might start a session by spreading postcards on a floor and asking people to select one to represent the type of day they have had. Metaphor and symbol are very Ruth Nolan significant.” Ruth is also working in collaboration with Kempsey’s Womens Refuge, an Aboriginal Women’s Support worker and a mental health worker. She values these partnerships. Since the program began, Ruth has witnessed significant improvements in health and wellbeing. “They tell me their stress levels are lower, they are sleeping better and how much they benefit from the contact with each other. They really look forward to coming as it’s a place where they can talk freely. Being all women makes it a safe place for women to express themselves “They report a different sense of community, establishing deeper connections and a sense of community as women. Discussions are underway for a Creative Arts Therapy, Grief, Loss and Trauma Retreat for Aboriginal women. I’d love to see the group expand as it’s clearly very valuable and it would be wonderful to see more women benefit,” Ruth said.
A moving exhibition Recently, the women who took part in the first creative arts workshop program run by Northern Rivers Arts Health and Wellbeing (NRAHW), were excited to see some of their art on the walls of the Serpentine Community Gallery in Lismore. The Conversations Through Art 10-week workshop was especially designed and run for women living with cancer and was funded through a Cancer Council grant. Three of the workshop facilitators had also been through the cancer experience. The works ranged from clay
pots to paintings, drawings, writing and a colourful group mandala which NRAHW has made into a greeting card as a fundraising item. Opening the exhibition, Lismore Mayor Jenny Dowell paid tribute to the courage of the women whose work was on display and pointed out that every single cancer journey was different but that giving women an opportunity to explore their illness through the creative arts was an important step in the healing process. NRAHW is hoping to run workshops soon for carers. For more about NRAHW, go to: www.nrahw.net
To teach or not to teach? By Dr Jane Barker Academic Lead in General Practice, University Centre for Rural Health, Lismore.
How can general practice meet the increased need for medical student placements?
Why should we teach?
Where is the value in providing medical education in general practice? There is evidence that it is the experience s student has with a general practitioner that greatly influences their choosing general practice as a career. Certainly that has been our experience at UCRH where many students in their exit interviews have expressed an interest in a career in general practice after a rewarding local GP placement. It is also vital that all doctors, whatever their final career choice, develop a clear understanding of the pivotal role general practitioners play in providing health care in the community. At least 80% of health care in Australia takes place in the community and with the increase in longevity leading to a rise in chronic disease and the practice of early hospital discharge, this is likely to rise. A lack of understanding among Australian doctors of the vital role of General Practice would be detrimental to the functioning of the health service. It is imperative that all medical students have a meaningful experience with GPs.
Burgeoning numbers of new students
It is impressive that a majority of practices in the northern Rivers Area are involved in medical education. General Practice workforce shortage was a key factor in the decision to increase student numbers and I do not doubt that general practitioners will be grateful for the eventual increase in trained GPs because we have all borne the brunt of these shortages over the last decade. However, these higher numbers are putting increased pressure on general practice to take trainees at all levels –medical students, prevocational trainees and regis20
It is imperative that all medical students have a meaningful experience with GPs. trars. Training at all these levels is vitally important. It is also apparent that while the demand has increased the number of practices involved has not. There has been a rise in demand on three levels for medical student placement. Firstly, there are more medical students.- an increase of 81%between 2005 and 2012 Secondly, because greater exposure to general practice has increased the likelihood of graduates choosing a career in general practice, many medical schools offer more than one general practice placement. The best predictors of doctors taking up a rural career are rural origin and repeated exposure to rural medicine. Two programs which have responded to this – and which affect us locally – are the University Centres for Rural Health where students are placed for an academic year in a rural area and the RUSC program which requires medical schools to provide all medical students with a 4-6 week rural experience.
The third level of pressure comes because the program of a limited number of medical schools involves a long term placement in general practice. In this area the UCRH hosts 21 students from Wollongong Graduate Medical School, who are attached to general practices for the academic year. This program has been well received in this area and many of those doctors involved feel they are making a significant contribution to their students’ medical education and prefer them to shorter term placements. The students themselves highly value these placements and the breadth of the education they receive.
What is the value in GP teaching?
Wollongong GMS has been involved in assessing their graduates following their first year as interns. The results suggest that their graduates are performing as well as or better than their counterparts. This suggests that general practice is a beneficial arena for medical training which is certainly a credit to those GP supervisors involved in their program. General practice provides a fertile ground for training in chronic disease management,
patient centred care communication continuity of care across the ages preventative health care patient education those areas specific to community based care.
Putting on pressure to improve PIP payments!
While for many GPs teaching increases personal satisfaction and professional well being, it should not be at the personal or financial cost to the practitioner. The two main barriers to hosting medical students are consulting room space and the financial impact. Timely and more equitable remuneration is vitally important to retain GPs who teach and to increase our student numbers. The UCRH is urging the medical school deans to lobby the government and the universities to address this issue. A recent statement from the AMA says that they have called on the government to improve support for general practices involved in teaching, including doubling the PIP payment. AS GPs it is important that we take ownership of these programs, both for workforce support and succession planning, but also to promote general practice as a teaching arena equal in value to our public hospital system.
A day in the life of a mental health nurse life changes – a heart attack and the loss of her long-term gentleman friend. She is severely traumatised and afraid that she will not be able to manage financially. I take her to her doctor to arrange for some sleeping tablets to get her through the next few nights and we also make an appointment with a dietitian so that she can learn about her new diet. It turns out that Serifa has a beautiful granny flat underneath her home that she had decorated for her gentleman friend when he came to stay and I suggest she might be able to rent this out in future to increase her income. She seems happy with this idea and calmer when I leave.
By Wendy Hall Credentialed mental health nurse NCML
Visiting Daisy The first visit of the morning is to see Daisy an 83-year-old lady who lives in a seniors village for an assessment. Her doctor has put her on new anti-depressants following an attempted overdose on 10 paracetamol tablets, and has requested that I review Daisy’s situation so that she can get some support measures in place. I am greeted by a neatly dressed lady, impeccably bejewelled and made up, who lives in a house that could be in House and Garden magazine. It is full of family photographs, with old-fashioned teddy bears sitting on various chairs and sofas. The photos tell of a life well lived, full of adventure and loved ones Daisy makes up a pot of tea in a teapot covered with a knitted cosy, and pours us a cup each. She has shaky, arthritic hands. I remind her that I have come by at her GP’s request to see if I can give her any support following her serious attempt to kill herself. Daisy starts to cry her eyes out. She cries and cries and all I can do is hold her hand across the table, a stranger suddenly subject to this lady’s innermost thoughts and feelings. When I ask her whether she wanted to tell me anything about the reasons for her recent suicide attempt Daisy surprises me with her answer Daisy admits that she suffered sexual abuse at the hands of her adoptive father as a young child. As a result of this, her adoptive mother who knew about the abuse, mentally and physically abused Daisy herself. This was because she was jealous of Daisy getting her father’s attention. These adoptive parents were in their 50s when they took Daisy on. Daisy left home early but ended up coming back. Daisy nursed her adoptive mum until her death with cancer but her mother never apologised for her abuse. Daisy then began HealthSpeak
Wendy Halll with NCML Manager, Bob Boss-Walker.
to nurse her dad when he was dying. However, one day she discovered her sick, dying dad sexually abusing her own baby daughter At this point she threw him out of the house. Daisy said she had never told anyone except her own daughter about these events and she did not relate them to the extreme anger and then depression that she had experienced for most of her adulthood. She had married happily but never mentioned the events to her husband either. Anti-depressants had taken the edge off her suffering over the years. Then at the age of 80 after her husband died, Daisy became fairly reclusive and a lot of the bad feelings came rushing back. At that point she began to feel, again, that life was not worth living. I tell Daisy that I think my colleague over at sexual assault services might be able to help, and luckily she can and even agrees to visit Daisy at home. I offer back up support while she is seeing the sexual assault counsellor which Daisy accepts.
Advocating for Susanna My next appointment is to see Susanna who has schizophrenia and a learning disability. She has just been talked into buying a
One day she discovered her sick, dying Dad sexually abusing her baby daughter. At this point she threw him out of the house. new mobile phone and an iPad by a salesman. She explains that she had only gone into the store to buy some phone credit. It turns out the deal is going to cost her 80 dollars a month which Susanna can’t afford. And it also turns out the salesman has told her to pay it by internet banking which she doesn’t know how to use! So I take Susanna back to the store and ask to speak to the manager. I strongly suggest that the salesman has breached his duty of care towards Susanna by talking her into this stuff. The deal is undone. After this, I go to the home of Serifa, a Bosnian lady in her late 50s who has just had two major
Peer support At lunch I meet my two colleagues for some peer support, then it’s off to a caravan park to see Herbert who has a diagnosis of schizophrenia. While Herbert is liked by the other residents of the park, he has been getting into grief by urinating loudly outside his van at night. The recently appointed new manager of the park has told Herbert that he will be thrown out if he does this again. He is worried because he has lived there for about 12 years. We talk about Herbert’s reason for doing this and about the need for it to stop. Herbert admits that he thinks that his new manager has it in for him, and that he has been angry and expressing this through the urinating. I go to the manager after our talk and tell him that Herbert has agreed to try hard not to urinate loudly again and everyone seems less angry after the communication.
Looking to the future Next it’s a walk on the beach with a client who can soon be discharged and we discuss her plans for the future. Then back to the office to make notes and another day is over. Tomorrow, as always will be completely different. 21
Championing inclusion in aged care The federal government recently announced that Australia's gay and transgender community will get their own aged-care strategy as part of a $3.7 billion reform package for the sector. But the biggest aged care provider in NSW and the ACT, UnitingCare, has already taken the lead in reaching out to the Lesbian, Gay, Bisexual and Transgender and Intersex (LGBTI) community. In a novel move, since January Kellie Shields has been working as UnitingCare’s LGBTI Project Officer for NSW and the ACT to develop partnerships with community and health organisations. Based in Lismore, Kellie is excited about the potential of her role and the opportunities to allow the LGBTI community to shape the future of aged care to best suit their needs. She has been part of the aged care industry for 25 years, starting as a diversional therapist. “I really hope to make a difference in bridging that gap of past
and preconceived discrimination when it comes to the LGBTI community,” she says. With consultation and inclusion as its foundation, the project has a steering committee composed of leading independent LGBTI health and research professionals. Kellie told HealthSpeak that evidence shows that there is often a reluctance by LGBTI community members to access health and aged care services, especially from faith-based organisations. This is generally as a result of both real and perceived discrimination. “That’s where people can go back into the closet, afraid to disclose their sexuality or gender because of the fear of being stigmatised and treated differently. I can tell them that times have changed and aged care is not the same as when Grandpa was being looked after,” she said. Kellie explained that UnitingCare has a person-centred approach to its services and it’s not
enough to say ‘We treat everyone the same’ – but that we need to know a person’s story. “We need to be aware of the particular needs of various consumers and tailor our approach to meet them, honouring the diversity in our community,” she said. Next month UnitingCare is holding a community consultation event to hear the views of members of the LGBTI community and how aged care can be shaped to meet the particular
Nasendoscopy showcases the voice
A fascinating and entertaining evening is coming up in Lismore in September. NORPA is presenting a live art work combining multimedia, theatre and music for audiences to witness the surreal, sonic experience of a singer in conversation with her voice. Pre-recorded vocal utterances, captured through nasendoscopy imaging are used to frame this piece which is part of The Visual Voice – an ongoing project conducted by a team including 22
A screen will throw up images of Heather Keens’ voice box as she sings.
Heather Keens (singer), Frank Millward (composer) and Mr John Rubin (ENT surgeon). This conversation visits a musical world that features the speech quality of jazz and popular singing forms alongside the operatic. Through technology, the voice is presented, distorted and reconfigured while asking
the question – is the voice lost in the maelstrom of remediation? Always being mindful of the irony involved when someone is in conversation with themselves this work may make you chuckle. Warning: Moving images of internal body parts may offend! For more info, go to: www.norpa. org.au.
needs of these people. Kellie said that education and training of aged care staff was vital in succeeding in meeting the aged care aspirations of the LGBTI Australians. “They need to know that our aged care facilities are a safe environment for them to be themselves and that our staff will not assume they are part of a heterosexual couple, but that paperwork and conversations will be inclusive and accepting.”
Cancer surgery wait times on MyHospitals website Information on cancer surgery waiting times is now on the MyHospitals website managed by the Australian Institute of Health and Welfare (AIHW). The website presents cancer surgery waiting times for public hospitals, showing the median waiting times (in days) for selected cancer types in each hospital. Waiting times refer to the time spent on a waiting list by people who received elective surgery for selected cancer types between July 1 2010 and June 30 2011. The types of cancer for which waiting times are shown are: bladder cancer, bowel cancer, breast cancer, gynaecological cancer, kidney cancer, lung cancer, melanoma and prostate cancer. The median waiting time is the number of days within which half of all patients at a particular hospital received their surgery. The website also presents information for each hospital on the total number of admissions for elective cancer surgery across the selected cancer types. The website is available at www.myhospitals.gov.au.
When is the next Share Market Boom?
As we move towards the end of 2012, most investors around the world are exceedingly nervous as they watch unfolding events. It doesn’t look too good. Four years after the start of the Global Financial Crisis there is still no end in sight. But end it will. Investor confidence will return and share markets leap forward with unbounded optimism – just as they always have in the past. The question is: When? There are a few problems to sort out and a big realignment needed in investor sentiment. But 10 years from now we are likely to be in one of the strongest bull markets we have ever seen. It will be driven by strong growth in developing countries and scientific innovations ranging from robotics, new manufacturing process, technological change, genetic engineering, medical and bio-tech advances, an agricultural boom and other factors we haven’t thought about yet. In the short term there are some issues to be resolved before the longer term can take hold. The Euro is going through what looks like its death throes. Trillions of Euros are being shuffled around, printed, lent and borrowed to try to avoid a demise that appears to be inevitable. Europe, like the US and Japan, is suffering from excessive debt HealthSpeak
and there are no easy answers. That debt has to be dealt with and someone has to pay. It will be borrowers, lenders (via defaults or high inflation) or long suffering taxpayers or all of these. How it will work itself out is unknown – it could be a long drawn out affair or life support could be turned off quickly. The latter option, which would probably mean the complete collapse of the Euro, looks increasingly likely. Some economists suggest we should put it out of its misery and rebuild something new. This would be catastrophic in the short term but allow a stronger recovery later on. Meanwhile the US Government is facing a fiscal cliff. It is saddled with debt and by September the old debt ceiling imposed by Congress will re-emerge as an issue – right in the middle of an election campaign. If nothing can be renegotiated, come year end there will be huge spending cuts and tax increases, already legislated, which will surely drive the US back into recession. China is slowing down, in part because it wanted to curtail inflation and a property boom and in part because it is a maturing economy where growth rates of 10 per cent a year are impossible to sustain. Japan is the most indebted of all developed governments with
debt equal to 208 per cent of GNP. Much of this is maturing over the next two to three years. As someone said recently, Japan is a bug in search of a windscreen. Over the next 12 months all these issues will come to a head, if not before. Hang on to your brollies. So will we see a rebound after that? Old-timers such as John Mauldin, author of The Little Book of Bull’s Eye Investing, suggest that this bear market will probably hang around for a while yet. As the accompanying charts show, the last bull market started in 1981 and lasted 19 years. They were glorious times. The last bear market started in 1965 and finished in 1982 – 17 years. Since 2000 we have been in another secular bear market. It started in 2000 and if history is any guide
Ten years from now we are likely to be in one of the strongest bull markets we have seen
continued page 24
Seeking full-time GPs for Bonalbo
The main street of picturesque Bonalbo.
Nestled in the Upper Clarence Valley in northern NSW, picturesque Bonalbo is just two and a half hours west of Byron Bay and 45 minutes from the Queensland border. The town’s much-loved former GP, Dr Trevor Tierney, retired at the end of last year after 31 years of dedicated service to the people of Bonalbo, Tabulam and surrounding villages. Trevor was an old-fashioned GP, working at his practice five days a week and on call 24/7 for emergencies. But at 65 he knew he had to slow down, and he’s off pursuing his dream to study at art school. Since Trevor’s departure, the community’s primary health care needs have been met through a roster of casual GPs working up to five days a week. At the moment, GPs work in the clinic attached to the hospital
and a new GP could negotiate to use these same facilities. Rural Generalist skills are required. There is VMO access to the 10-bed Bonalbo hospital during daytime hours only. GPs also have responsibility for patients in Bonalbo’s aged care facility. Generally patients from the facility are brought to the clinic, just a few doors away. This opportunity would ideally suit full-time GPs, a GP couple or partnership. Bonalbo has a pharmacy, ambulance station and a helicopter landing site for emergency cases to be flown to Lismore or Brisbane for specialist services. For details of remuneration and other information about the position, contact North Coast Medicare Local’s Northern Rivers General Manager Chris Clark on 6622 4453 or email: cclark@ ncml.org.au
from page 23
regarded as value investors, interest rates and inflation cause P/E ratios to change over time. These changes underlie bull and bear markets and set the overall trend. When interest rates rise, bonds and other interest bearing investments become more attractive and share prices fall even though company earnings have not. As a result the P/E ratio falls. On the other hand when interest rates fall, then P/E ratios expand. If you look at the charts, the last bull market started in 1981, a period when the P/E
still has a few years to run. The charts are a little different to most you see. They are not charts of share prices but of share value- the P/E ratio (this is the share price divided by company annual earnings per share). If everything was relatively stable, P/E ratios would not change much. For example, if company earnings rose, the share price would also rise and the P/E ratio would stay the same. According to Maudlin, Warren Buffet and other analysts 24
Cancer treatment info from across the state now available online
Cancer patients and GPs in NSW now have access to a more coordinated approach to accessing information about cancer treatment across the state. The Canrefer website set up by the Cancer Institute NSW, allows general practitioners and people diagnosed with cancer and their families to search for healthcare teams specialising in the treatment and care of specific cancers. The program allows people to search for their closest specialist healthcare teams. It also gives them access to information including the radiation oncology, chemotherapy, palliative care and cancer genetics units closest to where they live. Using a Google search function, visitors to the website can search for information according to the geographical location and type of cancer to be treated.
ratio was less than 10. It was a time of high interest rates and high inflation. In fact all the bull markets over the last 100 years or more started when P/E’s were 10 or less. Over the two decades since 1981 interest rates and inflation fell creating a huge expansion of P/E ratios and reaping huge rewards for shareholders. We are now in a completely different situation. P/E ratios are more than 20 for the US market and 15 for the Australian market - maybe not overvalued but not cheap. As
The information in Canrefer will help general practitioners in referring newly diagnosed cancer patients to specialists attached to multidisciplinary teams and support timely referrals as early on in the cancer journey as possible. The development of online cancer services directories for all Australian states and territories began as part of Cancer Australia’s CanNET Program. The Cancer Institute NSW developed Canrefer, the NSW directory, with the assistance of cancer services personnel and support from NSW Health through the Health Establishment Registration Online (HERO) Project. The website also offers practical information including maps, opening hours, parking facilities and contact details for cancer care coordinators. Go to: www.canrefer. org.au
well, inflation and interest rates are low. An expansion of P/E ratios does not look likely. These are not the conditions for another bull market. However if inflation rises (or deflation occurs) then this market will look to be very expensive. If so, P/E ratios and share prices will fall. Ouch! So a new bull market is some time off. In the meantime however there will be rallies and astute investors will make money. But you’ll need to be careful.
Mullumbimby Hospital says ‘Goodnight Doctor’
Nestled in the deep north of the Byron shire is the old Mullumbimby hospital. Built in the 1960s it has the style of the time, a long corridor with the patients’ rooms looking out onto a nice sub-tropical garden. It had an operating theatre, a labour ward and a nursery. GPs ran everything, including the after hours roster. It was like that when I arrived in 1975. Unknown at that time, it had a major flaw, a true time bomb in the ceiling. Asbestos. When I started work in this snug hospital, night followed day as far as duty was concerned. Every practising doctor was expected to catch babies and work in the emergency department as part of country practice. Now it’s in the news. The Echo, our local paper is buzzing with news that the longstanding tradition of duty night doctor is to be replaced by a video link to a doctor at Tweed Heads hospital. According to some editorial letters, many people think that doctors working at night is still the deal. Indeed, some of the senior long-serving doctors still gave battered vestiges of loyalty, but Dr Rosie Hamilton, a parttime GP, wrote in to clarify the more contemporary situation, saying ‘to me, moving to this area to live and work, in no way obliges me to work after hours in emergency.’ The strange thing is that there is no shortage of locum doctors HealthSpeak
willing to do night call because the hourly pay is generous. The problem for the bean counters is lack of patients, averaging two per night - a waste of money. I have worked this shift and often just slept through. Of course, life threatening emergencies do come in, that’s for sure, and having a doctor present helps the patient, their relatives, the nurses and the ambulance. Considering the under-utilisation of the after hours service, it’s surprising how much this move has worried the community. One local woman who did turn up with a moth flapping in her ear wrote to The Echo, glowing with praise for the service. She was seen by ‘a handsome young doctor in blue jeans sporting designer stubble. I fell in love with the doctor and the medical service.’ Is this over-servicing, or a standard the public have come to expect of the night doctor? Certainly a hard act to follow for the unblinking eye, but the lady affirmed the fears of many I’m sure. ‘I would have to explain to a camera lens my distress, my fear, my terror.’ But wait a minute. How will this Big Brother doctor eye operate? Does the patient front up to emergency and press the eagle button like the police station at Brunswick heads and wait for lens fixation. That’s how it sounds and maybe it’s a pity that some thought for public educa-
tion was not rolled out with the program. One really good thing, there is always a nurse on duty. I can say that the Mullumbimby nurses are well trained and helpful and supposedly would do most of the talking with the distant doctor in camera. Some staff members say that this new measure is a way to close the hospital. Mullumbimby, like many other small hospitals, is often under threat of closure. It seems that any excuse will do but public outrage does provide something of a handbrake and it’s not the first setback for this country hospital. When the curtain went down on theatre in the late ‘80s, it was a great loss because Caesarians and epidurals were no longer available. Local doctors could no longer offer the convenience of minor surgery. Skills atrophied. It was a sad fate but just a symptom of changing times. There was one positive outcome. In the absence of facilities, birth had to become natural or stop. Midwives, doctors and women all adapted, even with the inclusion of water as a birthing tool. When the plaster started falling off the ceiling around the nurses’ desk about 15 years ago, the hospital had to be closed for asbestos containment and it was given a shelf life of a few years, now long passed. Emergency services were moved into temporary accommodation in the CWA building. Significantly then, night services were suspended for the first time and everyone managed. Now the community is waiting for the long ago made promise by successive governments for a new hospital at Ewingsdale. Some people are cynical enough to say that this new cutback is a ploy to close Mullumbimby hospital altogether. After all, it’s not too far to Byron Bay and only a quick drive to Tweed Heads. Mullumbimby Hospital? Hmm. Nice piece of land.
One local woman who turned up with a moth flapping in her ear wrote to The Echo glowing with praise for the service
Psychiatrist with a passion for people Psychiatrist Peter O’Brien works at a North Coast Aboriginal Medical Service and also sees patients at a Grafton clinic under a program funded by North Coast Medicare Local. Peter trained as a GP and worked in Dapto before completing his psychiatric training. He has worked in both public and private settings in the Wollongong area. He has also worked as a Visiting Medical Officer on the South Coast of NSW and at Goulburn Hospital. When Peter, his wife Sue and their family moved to the Northern Rivers in 2005, Peter began working at various Aboriginal Medical Services - Bulgarr Ngaru (Grafton), Galambila (Coffs Harbour), Durri (Kempsey) and Bowraville and as a visiting psychiatrist at Kempsey and Grafton jails. In 2008, Peter and Sue, who’s a physiotherapist and asthma educator, moved to the Pilbarra region in Western Australia where he took a job as Clinical Director of an area seven and a half times the size of Ireland. Peter is a veteran of videolink consultations, estimating he’s spent more than 3000 hours using this technology to access patients in remote areas. “Generally I find videolink consultations very good. I’ve been doing them since 2000 and have used videolink to carry out ward rounds in Goulburn Hospital. “The biggest challenge is if you are not familiar to the with the region you are linked to and not aware of the resources available for patients. But overall the technology is very useful.” Before moving to the Pilbarra and then Darwin, Peter’s wife Sue decided he needed something else in his life apart from medicine and bought him an introductory flying lesson for his 50th birthday. “So he used to hop in the plane at Coffs Harbour and fly to Kempsey to work and when we were in Darwin Peter used to fly to the Tiwi Islands for fortnightly clinics,” she said. 26
Dr Peter O’Brien at the Barkly Homestead outback roadhouse in Queensland with his plane.
Sue would fly with Peter often but said some flights had been nerve-wracking. “Not long after he got his pilot’s licence we flew from Bundaberg to Darwin and he couldn’t get the GPS in the plane to work. We had to find our way looking out for roads and railway tracks. “I prayed all the way,” said Sue. After working in Darwin, the O’Briens moved back to some acreage near Coffs Harbour. At the time, Peter said people would ask them what they would do back in NSW. “I said: ‘I’m going back to jail and my wife is going to a nursing home’. At the time Sue was (and still is) working in aged care facilities,” Peter laughed. On their return Peter worked as Clinical Director at Coffs Harbour Psychiatric Rehab Unit before returning to clinical work with patients. He also conducts clinics on Lord Howe Island (which is in the North Coast Medicare Local footprint) two or three times a year. Nowadays, Peter is a skilled pilot and also works as the local
aviation medical examiner in Grafton. As well as working with patients, Peter also works to improve rural psychiatry as a member of the Rural Specialist Interest Group for the Australian and New Zealand College of Psychiatrists and is also on the College’s Continuing Education Committee. These days Peter is trying to reduce his working hours and he’s now ‘out of jail’. He’s also grateful for the assistance he gets from mental health nurse Scott Hanson who comes into the clinic twice a week to help with patient follow-up and monitoring of both medications and people’s progress. Scott also does some therapeutic work with patients. Clearly a person who loves people, Peter says he enjoys seeing positive change in his patients. “In psychiatry you get the opportunity of helping people and any improvement you can make to the patient’s wellbeing usually has an effect for a long time,” Peter told HealthSpeak.
Peter estimates he’s spent more than 3000 hours on videolink consultations to access remote area patients.
Books with Robin Robin Osborne
Vital Signs Ken Hillman New South - $32.95 Actively working doctors seldom write books for the general public, so if only for this reason Ken Hillman’s “Stories from Intensive Care”, in the words of his sub-title, is to be welcomed. Although the names of patients have been changed to protect their anonymity, no other truths are held back in this intensive care specialist’s rare and welcome insight to the world of the hospital ICU, a place where an increasing number of Australians are ending their days. As Dr Hillman explains through a series of deeply moving case histories, this fate has less to do with the quality of ICU care, which is excellent, than the modern way of dying, focused on using every tool in the technological basket
Retreat for those touched by cancer A three-day retreat for people who have or have had cancer and are medically fit will be held at Grassy Head on the mid north coast in October. Funding for the retreat is made possible through North Coast Medicare Local’s ATAPS program. The retreat gives participants the opportunity to discover ways in which psychosocial education, discussion, gentle yoga, mindfulness meditation, laughter, creative arts therapy and relaxation practices can help physical and emotional challenges associated with illness. Facilitators are NCML psychologist Sue Baughman and Creative Arts Therapist Ruth Nolan. Held at the Yarrahapinni Adventist Youth Centre, there are private walks to the beach and
to extend lives that cannot – and often should not, in his view - be saved. “I have feelings of increasing unease around the futility of sustaining life in certain of our patients in the ICU,” he tells us with great honesty. “Of the nineteen patients we had in the ICU on that morning ward round, there were seven patients, including Gladys, where continuing efforts to sustain life could be seriously questioned. “The death bed has moved from the comfortable familiarity of the home to the science fiction of the ICU, surrounded by caring people who are also, nonetheless, strangers, inflicting the high-tech world of modern medicine in indiscriminate ways on people who may just want peace and dignity.” Summarising his case in the bluntest of terms, he adds, “Within a matter of a few years, it seems that all our sick and dying come to intensive care on their way to their eventual death.” This is a debate that society should be encouraged to have, especially in an era when out-ofhospital palliative care, whether at home or in a specialised facility, can be provided better – for both
New trial using MS drug
a boardwalk through rainforest. Cabin accommodation is provided. For more information about the venue go to: www.yarra.org.au and to find out more about the retreat phone psychologist Sue Baughman on 0414 943 691 or email: sbaughman@ ncml.org.au
A world first trial is being conducted in Sydney and Newcastle using a multiple sclerosis drug to help people quit smoking cannabis. Hunter Area Director for Drug and Alcohol Clinical Services Adrian Dunlop says the MS drug Sativex could be the help they’re looking for. He says 50 cannabis users are now being sought for the trial. “It’s a medication that has two of the active components found in cannabis. One of them is THC and the other is CBD or cannabidiol and these two compounds are in a specific ratio
patient and family - than ever before. According to Dr Hillman, “This situation is not helped by the lay impression that medicine now has an answer to almost all problems.” Perhaps unfairly, given the family pressures on them to prolong life, he appears to attribute some blame to his colleagues. “The medical profession has been slow in correcting this image. As with the birthing process in the 1950s, medicine has placed the patients behind heavy doors and arranged them for inspection at specific times and for limited periods.” Just as the start of life used to be overly managed, so, increasingly, is its ending. This book sounds a timely wake-up call for the whole community to start doing things better. Birth and death are our twinned fates, and having almost sorted out the former, we owe it to our elders and ourselves to improve the latter. Long-time North Coast resident Robin Osborne was media manager for the former North Coast Area Health Service, and until recently Media Director for Northern Territory Health in Darwin.
in the medication and they have been used to treat some of the problems with MS,” said Dr Dunlop.
Evidence ‘skewed’ to pharma products The president of the Australasian Integrative Medicine Association says medicine can focus too much on evidencebased research and risk stifling innovation. Professor Kerryn Phelps, defended a surge in Medicare spending on chiropractic and osteopathic treatments. She said taking away subsidies for alternative treatments that had limited research to support them would deny care to the poor, and favoured more researched treatments backed by drug companies.
Help save lives by advocating mammograms
BreastScreen North Coast is asking for the help of health practitioners in encouraging women over 40 to book in to have a mammogram every two years. The BreastScreen program on the North Coast offers free mammogram appointments at its Tweed Heads, Lismore, Coffs Harbour, Port Macquarie and mobile sites. All women over 40 years of age are eligible to attend. The program especially urges women aged between 50-69 years to make the call to have a screening mammogram as they are in the high risk age group. BreastScreen North Coast Director Jane Walsh said currently many hundreds of women in the region were not not screening at all or not screening every two years. She said once was not enough.
“Although a GP referral is not necessary, patients listen to their GP or allied health practitioner, and if they are encouraged to have a mammogram it is likely they will take their doctor’s advice,” said Jane. The four sites have the latest digital technology and if a patient is called for further investigations they are completed at the assessment clinics at no cost to patients. Currently thermal imaging is being promoted, but the National Health and Medical Research Council warns against using breast thermography for early detection of breast cancer. Please help us by advising your female patients to ring 132 050 every two years to book their free screening appointment.
GP consults in pharmacy
A new service allows patients to walk into a pharmacy, sit in a booth and wait for the next available GP to appear on screen. More than 100 GPs have signed up to the ConsultDirect service, owned by Medilink Australia. It’s a private telehealth scheme enabling them to consult with patients sitting in video booths in pharmacies. The service is not covered by Medicare; patients pay the
pharmacy $45 and the GP invoices the pharmacy for $40. GPs can log into the system in their spare time to see whether patients are waiting. At the end of the consult, GPs can fax prescriptions through to the pharmacy. The service is now available in 14 pharmacies but the Medical Council of NSW is urging NSW doctors to seek legal advice before taking part.
Online tool a real asset for internal communication During a recent practice brainstorm activity, the clinical team at the Mullumbimby Medical Centre came up with an efficient and easy to replicate communication tool to ensure staff and practitioners who work and are associated with the practice are kept up to date. Chiron Weber, who works alongside his father Dr Norbert Weber at the practice, said he set up the blog/forum as a convenient way to exchange ideas for future planning and suggestions to streamline practice activities. It is also a convenient way for staff to keep up with all the ‘stuff ’ that they are required to know to keep the centre running smoothly. Chiron said Wordpress was recommended as the platform for the forum – which is really a blog set-up that he has turned into something more. The setup allows for items to be posted and commented on by all members that are part of the blog. Chiron explained that staff simply sign on to the forum. They do need to turn on email notifications so that every time something is posted, they are informed and can then turn to
the forum and check it out. It’s also important to ensure the blog settings are set to ‘invite only’ to keep the blog private. Chiron said this tool means that staff meetings can be used for important business discussions while the other ‘stuff ’ can be posted online for staff to peruse, comment and discuss at their convenience. The blog can also be visited during staff meetings to finalise any discussions occurring online and make decisions on items raised. He is also inviting registrars, medical students and past staff members to access the forum so that they remain involved with the practice and can comment on ideas and practice improvements. Chiron told HealthSpeak the blog was still a work in progress. “Some staff members are not yet active, however everyone willing to get on board. With busy schedules this tool can be used for strategic planning, discussions and suggestions. A blog/forum is an excellent way to communicate ideas amongst staff and receive feedback on ideas and plans from all team members”, he said.
Hitting the streets
From left: North Coast Medicare Local took the opportunity to take to the main street of Coffs Harbour for Men’s Health Week. In the photo, Peter Murphy from the Men’s Shed Adele Maynard of Coffs Area Men’s Alliance, Terry Donovan from NCML’s Close the Gap program and Lyn Dalgliesh, RN NCML diabetes nurse (with stethoscope). HealthSpeak
Wine and good health Chris Ingall
Well, hello again dear readers. A new start in a new journal, HealthSpeak no less, so what could be more appropriate than to speak (or rather write) about wine for health. Readers who have perused previous columns will know I believe the two (wine and health) to be synonymous, for excellent reasons of course. The documented benefits of red wine on arteries, and moderate alcohol to help us forget the troubles of the day just passed, speak for themselves. I am presently in the middle of a ‘Dry July’, raising money for a local cause and it is very testing on my good wife, I can tell you. She feels a little alcohol with the meal at night makes her blood pressure that much lower, especially if I’m the one drinking it. It seems I can ruminate and protest too much if I am starkly sober. My personal view is that, while a little alcohol is beneficial, far more important is the way the alcohol is presented. Societies where beer is the predominant alcoholic drink will fall upon the twin swords of obesity and urinary retention, while spirit drinking peoples (think Russia HealthSpeak
or Northern Queensland, with vodka and Bundy rum respectively) too quickly move from sobriety to either a maudlin or aggressive state. Wine drinking on the other hand, as Thomas Jefferson once remarked, is a sign of an evolved civilisation where women and song are better appreciated (maybe he didn’t say that, but he meant to). He did say however “No nation is drunken where wine is cheap; and none sober, where the dearness of wine substitutes ardent spirits as the common beverage.” Maybe that’s why my daughters love Marlborough sauvignon blanc...it escapes our taxes. Mind you, I have seen them not sober on this wine. I could go further to suggest the quality of the wine plays no little part, and people who limit themselves to small to moderate amounts of good quality wine will outlive the teetotal. How many of your friends are calorie/ carb obsessed, can tell you their weight and girth to within an inch of their lives, but are eking out a miserable existence as a result? The antidote to this of course is wine! A little tipple taken with the meal will make you forget your worries and enjoy the moment. Enough to relax tense internal structures (read sphincters and arteries), aid digestion and lower your spouse’s blood pressure. Who knows what may come of this, if you’re lucky! And if the wine has been good, you will not pay for it the next day, but rather will feel pleasantly unhinged from your worries, unburdened. Which wines you say? Why all of them to a point, but whites three to four years old and reds seven years plus are my favourites, for they are mellow and softer, yet retain their flavours. The evolution of the wine in the bottle is nothing short of a miracle, much like ourselves as we age, and should be encouraged. Having a cellar allows this to occur at home, but with our present wine lake there are many suppliers who are unloading ‘vintage ‘ wines which have largely been well-cellared. So ‘wine as panacea for the ills of our age’; an attractive banner to march under, and I can think
of none better. Why, the saying ‘in vino veritas’ does not invoke wine over other beverages for nothing; wine has a certain je ne sai quoi, maybe just the right amount of alcohol to encourage discourse, maybe the right amount of acid and flavour to distract us from more pressing matters, and maybe a little magic to perform the alchemy required to bring us closer together and ease our slumbers. As Emile Peynaud, the great French wine critic remarked, when asked what were the five best wines he had ever tasted “I could tell you hundreds of wines, but instead I will tell you the names of the five people I would drink them with”.
Cellar Tip What could I tell you about which would be useful to you and help save the Aussie wine industry? Starting a cellar of course! There will never be a better time to work out what you will be drinking for the next 10 years or so. And how to do it cheaply? Well, find the best wines under 10 dollars which will improve over time; Houghton’s Classic White (used to be Houghton’s White Burgundy) - this contains a goodly proportion of chenin blanc, a white varietal which ages beautifully. I drank a 2003 the other day which was glorious! Great mouth feel and length. Also just about any riesling from the Clare or Eden Valley. Leasingham and Pewsey Vale are classics, with 2010 especially good. These wines will age wonderfully, developing lovely toasty notes to warm your cockles on a cold winter’s day, and still go with any white meat over summer lunch. The most versatile grape I reckon. And for a red, the humble Leasingham Bin 61 shiraz or Bin 56 cabernet malbec are quality Clare Valley reds for under $20, and are well structured to handle the opportunity of time.
October 3-7 PRIDoC 2012 – 6th Pacific Regions Indigenous Doctors’ Congress Theme: Connectedness To be held at Alice Springs Convention Centre Organised by The Australian Indig-
25-27 The Conference for General Practice To be held at the Gold Coast Convention Centre Leading primary care is the overarching theme of the conference, focusing on practical skills to support your daily practice. Professor Clare Gerada, Chair of the Royal College of General Practitioners, will deliver the Stuart Patterson Lecture Leading Primary Care: Health reforms, the UK perspective. Register at: www.gpconference.com. au/registration/
Who succeeded Robert Menzies as Prime Minister of Australia?
Painter Joshua Reynolds was knighted by which British Monarch?
What is the capital of Morocco?
Steve Harley was the lead singer in which UK band of the 1970s?
Duck and Dive represents which number in the game of Bingo?
According to the proverb, A stitch in time saves .... what?
What is the hardest substance known to humankind?
Who said: “That would be a good thing for them to cut on my tombstone: Wherever she went, including here, it was against her better judgement.”
In Sumo wrestling, a handful of what is thrown into the ring before a fight?
Who is on the front of the current $100 Australian note?
Tartarology is the study of what?
What was painter Rubens first name?
Which alcoholic drink is often referred to in literature as The Green Fairy?
What colour is the cross on the national flag of Switzerland?
The Isihara Test is used for testing what in humans?
In what Australian state or territory was the highest recorded temperature, of 53°C, recorded?
Arborio rice comes from which European country?
Which country will host the 2014 Olympic Winter Games?
Which actor was singer Madonna’s first husband?
Which fashion house has perfumes Dune and Poison?
Sufferers, Dreads and Locksmen are followers of which religion?
Which US author committed suicide with a shotgun in 1961?
In the game of Scrabble, the C tile is worth how many points?
Which epic poem by John Milton tells the tale of the fall of Adam and Eve?
November 8-10 National Primary Health Care Conference Theme: Healthy Communities, Healthy Nation “From Transition to Action: Integrating Primary Health and Social Care” To be held at the Adelaide Convention Centre Australia’s 2012 premier primary health care conference will be hosted in a new era for health. From July this year, a network of Australian primary health care organisations will be in place. Regional organisations led and governed by local clinicians and community leaders, Medicare Locals will integrate the delivery of primary health care, improve coordination, address service gaps and improve the ease with which patients can access health care.
ness 22. Italy 23. Russia 24. Sean Penn 25. Christian Dior
21 The 2012 International Emergency Care Symposium: “Building regional capacity: lessons learnt and the next steps.” To be held in Melbourne at The Alfred Hospital. International Emergency Care (IEC) is a rapidly growing field of interest in global health. It encompasses the work done by doctors and nurses in the evolution of emergency care systems in countries at extreme levels of development. Emergency care providers are collaborating across the globe to provide emergency care capacity development, emergency care specialty development and international disaster response. The cost is $250 per person (inclusive of GST) Emergency Physicians and Other Specialties. $150 per person (inclusive of GST) All others (emergency trainees, nurses, medical students). Contact Catherine Pound on (03) 9903 0891. Email: catherine.pound@ monash.edu
22-24 The Inaugural Children’s Healthcare Australasia (CHA) Conference. Theme: ‘The Journey’. To be held at Doltone House, Jones Bay Wharf, Sydney CHA, with its new name, is broadening its focus with an exciting new premier conference. The conference will bring together participants from a wide range of professional backgrounds to network, consider the latest research evidence and be inspired by the latest examples of best practice in the care of babies, children and young people 0 – 17 years. For more info, visit: www. thejourneyconference.com.au
Who wrote the 1968 Novel: ‘2001: A Space Odyssey’?
14. Harold Holt 15. Rabat 16. Cockney Rebel 17. 25 18. Nine 19. Diamond 20. Dorothy Parker 21. Colour blind-
14-16 Brisbane General Practitioner Conference To be held at the Brisbane Convention Centre The General Practitioner Conference & Exhibition (GPCE) is Australia’s premier Primary Healthcare event. The GPCE delivers innovative solutions and practical strategies to improve patient care. It also provides access to the leading healthcare products and services all in the one location. This is a launch event for Brisbane, following the success of the established events in Sydney and Melbourne, where the GPCE is recognised by GPs as the major clinical educational event on the GP calendar. To register go to: www.gpce. com.au/en/brisbane/
16-19 Surfing the Waves of Change, Australian Association of Practice Managers Ltd National Conference Brisbane Convention & Exhibition Centre www.aapm.org.au
7. Absinthe 8. White 9. Queensland 10. Rastafarian 11. Ernest Hemingway 12. Three points 13. Paradise Lost
14-16 Skin Cancer Conference 2012 To be held at the Millennium Hotel, Queenstown, New Zealand Organised by the University of Queensland. Register your interest online at skincancerconference.com.au
enous Doctors’ Association Ltd www.pridoc.org/register.aspx
Answers: 1. Arthur C Clarke 2. King George III 3. Salt 4. Dame Nellie Melba 5. Hell 6. Peter
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OPEN extended hours MON, TUE, WED & FRI - 8.30am to 7pm Thursday - 8.30am to 9pm SATURDAY - 8.30am to 5pm SUN - 9am-1pm
Goonellabah Village, Oliver Ave, Phone 6624 2449
Goonellabah Physiotherapy Centre
Lismore & Ballina Free Call 1800 662 125
GOLD COAST VASECTOMY CLINIC Providing Vasectomies since 1993 Dr Greg Anderson Phone: (07) 5530 2822 Suite 5, Bell Place, Cnr Bell Place and Link Way Mudgeeraba Qld www.goldcoastvasectomy.com.au
Gabrielle Boyce and Associates 581 Ballina Road, Goonellabah Phone (02) 6625 2888 Open Extended Hours
NORTHERN RIVERS OCCUPATIONAL THERAPY Offering medico-legal assessments, home assessments, equipment prescriptions, OT driving assessments, RTW and occupational therapy consultation services. Area serviced from Tweed south to Grafton and west to Tenterfield. Reasonable rates, phone Kathryn Cooper on 0417 913 354.
GOONELLABAH MEDICAL CENTRE www.gmc.net.au
GP VACANCY GP full or partime wanted. Large accredited and teaching practice 11 consulting rooms, 2 theatres, 7 bed nursing treatment area. Full nursing support, diabetes educator, psychologists Contact practice manager on 02 6625 0000
APHS Pharmacy Lismore Located in The KG Lawrence Centre, 20 Dalley Street, Lismore Specialising in: t Aged care medication service t Innovative medication sachets - Winner, 2012 National MedicineWise Award t Hospital, inpatient and outpatient oncology services, including patient liaison t Cytotoxic and sterile admixtures t Prescription and over-the-counter medication. APHS Pharmacy can provide hospital staff with the necessary education to minimise risk and ensure best practice in the area of medication administration.
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