HealthSpeak Summer 2016

HealthSpeak THE VOICE FOR HEALTH PROFESSIONALS – FROM TWEED TO PORT MACQUARIE

Optimal care for all issue 14 • summer 2016

The health needs of people with intellectual disability page 13

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Farewell to NCGPT

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NCPHN’s GP Advisers

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Tresillian comes to Lismore

25 Acute Low Back Pain

Caring for our most vulnerable Head Office Suite 6 85 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Vahid Saberi Email: enquiries@ncphn.org.au Hastings Macleay 53 Lord Street Port Macquarie 2444 Ph: 6583 3600 Cnr Forth and Yaelwood Sts Kempsey 2440 Email: enquiries@ncphn.org.au Mid North Coast 6/1 Duke Street Coffs Harbour 2450 Ph: 6659 1800 Email: enquiries@ncphn.org.au Northern Rivers Tarmons House 20 Dalley Street Lismore 2480 Ph: 6627 3300 Email: enquiries@ncphn.org.au Tweed Valley Unit 4, 8 Corporation Circuit Tweed Heads South 2486 Ph: (07) 5523 5501 Email: enquiries@ncphn.org.au

Health Speak

editor Janet Grist

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ecember 3 was International Day for People with a Disability, an opportunity for HealthSpeak to look at the health care provided to these folk, an often forgotten group in our community. One of our region’s main Disability Support providers Multitask, kindly helped by providing some communication tips for GPs. Our disability feature on page 14 also sets out common medical conditions experienced by people with an intellectual disability and how

HealthSpeak is published four times a year by North Coast Primary Health Network. Articles appearing in HealthSpeak do not necessarily reflect the views of the NCPHN. The NCPHN accepts no responsibility for the accuracy of any information, advertisements, or opinions contained in this magazine. Readers should rely on their own enquiries and independent professional opinions when making any decisions in relation to their own interests, rights and obligations. ©Copyright 2016 North Coast Primary Health Network Magazine designed by Graphiti Design Studio Printed by Quality Plus Printers

HealthSpeak is kindly supported by

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through evidence-based assessment and treatments.

I’d like to wish all our readers a happy and relaxing Festive Season and look forward to bringing HealthSpeak to you in 2016. Thanks to the many health professionals and health and community organisations who have submitted articles to the magazine this year. These have added tremendous value to health care conversations across many topics. Keep safe during Christmas and New Year.

Reshaping mental health services

Contacts Editor: Janet Grist Ph: 6622 4453 Email: media@ncphn.org.au Clinical Editor: Andrew Binns Email: abinns@gmc.net.au Design and illustrations: Graphiti Design Studio Email: dougal@gdstudio.com.au Display and classified advertising at attractive rates

best to manage the screening and treatment of these patients.

Also in this issue an informative feature by rheumatologist Dr Chris Needs on acute low back pain and how to improve the care of patients presenting with this condition (Page 25.)

Low back pain is recognised as a major cause of disability with a quarter of Australians experiencing it at any one time; it’s the most common health condition that results in a person retiring from work early. Health costs for the management of ‘back problems’ in Australia in 2012 were almost $A4.8 billion.

Chris outlines the Agency for Clinical Innovation’s Model of Care for Acute Low Back Pain.

The Model’s key objective is to reduce pain, promote function and reduce long-term disability

acting ceo Michael Carter

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ith the New Year just around the corner, the promise of opportunity and renewal permeates all aspects of our lives.

How timely it was for Minister Ley to make the announcement on November 26 that the Primary Health Networks will be provided the opportunity to work with clients, community and service providers to renew and redesign the approach and structure of how primary care mental health services will be delivered across their respective regions. Having launched the NNSW Mental Health Integration Plan last month and being a member of IMHPACT – Integrated Mental Health Pact on the MNC, NCPHN is well placed

to facilitate the consultation, planning and design necessary to identify and implement reform to mental health services.

Given the scope of services and the proposed level of integration of a stepped service model, greater engagement with service providers (across Mental Health, Drug & Alcohol and others services) will be necessary. The approach will be to ensure all service providers have the opportunity to take part in how the future service delivery model is shaped. We will identify the positives of current services, where improvements can be made, and in partnership design a stepped care service model which places the client at the centre of the model.

This approach is in keeping with the broader Needs Assessment activity being undertaken across the region to identify health needs and available services which will allow assessment of priorities and identification of options to address a range of primary health service delivery

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issues.

The Clinical Councils, Clinical Societies and other service provider groups are well positioned to engage in the process of shaping mental health services and contribute to the broader Needs Assessment process. The Collaboratives currently underway are examples of the enthusiasm in our region to explore ways to integrate and improve primary health and the connectedness with acute care. Thirty participants in the Musculoskeletal Collaborative on the Mid North Coast and over 180 in the Chronic Care Collaborative in the Northern Rivers are seeking to realise the goal of making the North Coast not only the best place to receive health care but also the best place to provide health care.

I urge all readers to take part in the process of improving our primary health system. If you want to participate and are not sure how to get involved please register your interest at www. ncphn.org.au/get-involved. healthspeak Summer 2016

How private lives affect public health

clinical editor Andrew Binns

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omestic and family violence has been much in the news of late, occasioned by such dramatic events such as the death of Luke Batty at the hands of his father, and a series of killings, so far 63 deaths this year. The prevalence of this crime is alarming: one in six Australian women experience violence from a current or former partner.

The widespread community response has included involvement from state premiers and a commitment by the federal government to a $100M Women’s Safety Package to improve frontline support and services, leverage innovative technologies to keep women safe, and provide education to help change community attitudes to violence and abuse.

Often more hidden but equally concerning are the private lives under which many of our children are growing up. This significant public health issue was identified in a large US study called the Adverse Childhood Experience (ACE study). http://www.cdc.gov/violenceprevention/acestudy/ The study followed earlier findings that many morbidly obese Americans had been identified as suffering from physical, emotional or sexual abuse or other adverse trauma in their childhood.

I discussed this in the Spring edition of HealthSpeak – ‘Childhood trauma can trigger later life obesity’. However, as was found with further research, it is not just morbid obesity that can result from ACEs. The ACE study was a ground breaking US survey published in 2009. The survey which was carried out with over 17,000 predominantly middle class Americans measured 10 ACEs on a scale of either 0 or 1 adding to a possible score of 10. (See chart below).

Summer 2016 healthspeak

Adverse Childhood Experiences (ACEs) and prevalence in the US Kaiser Permanente Study Abuse Emotional (11%) Physical (28%) Sexual (28% women; 16% men) Household Dysfunction Mother treated violently (13%) Household member alcoholic or drug abuser (27%) Household member imprisoned (6%) Household member chronically depressed, suicidal, mentally ill, or in psychiatric hospital (17%) Not raised by both biological parents (23%) Neglect Physical (10%) Emotional (15%)

Some 67 per cent of respondents scored at least 1 on the ACEs, while 12.6 per cent had experienced four or more ACEs. There was a close relationship between ACE scores and health outcomes 50 years later. More importantly, the relationship was strikingly dose-dependent.

COPD was 2.5 times higher in those with an ACE score of >4; depression 4 times; heart disease

Illustration Jeni Binns

3 times and suicide 12 times.

Population attributable risk figures showed that 54 per cent of current depression and 58 per cent of suicide attempts in women could be ascribed to ACEs. These lead to what has been called ‘allostatic load’ which can accumulate over the years increasing the risk of many diseases.

So what can we do about this

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significant public health problem in general practice? Becoming a trauma informed practice is a good start as there is evidence that even acknowledging early adverse experiences can assist recovery.

When appropriate, for a GP to just ask about ACEs in a sensitive way often leads to disclosure and this in turn is followed by an appreciation that the problem has been heard and believed, with ongoing respect and support for the patient. This disclosure may not have happened before during a consultation with a health professional. Such an approach opens the way to plan for and arrange appropriate counselling and support.

Whatever therapy is advised, five foundational principles of managing trauma informed care should be considered. http:// www.recoveryonpurpose.com/ upload/ASCA_Practice%20 Guidelines%20for%20the%20 Treatment%20of%20Complex%20 Trauma.pdf 1 Safety – ensure physical and emotional safety 2 Trustworthiness – maximise through task clarity, consistency and interpersonal boundaries 3 Choice – maximise choice and control 4 Collaboration – maximise collaboration and sharing of power 5 Empowerment – prioritise empowerment and skill building “The new system will be characterised by safety from physical harm and re-traumatization; an understanding of clients and their symptoms in the context of their

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Commissioning in Primary Health Networks

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n his review of Medicare Locals, Professor John Horvath recommended that the new Primary Health organisations “should only provide services where there is demonstrable market failure, economies of scale, or absence of services”. The establishment of the Primary Health Networks (PHNs) in July 2015 signified a commitment to the use of commissioning for primary health care in Australia.

But what is meant by commissioning?

A dictionary definition of commissioning tells us it is to order or authorise (a person or organisation) to do or produce something. This is opposed to purchasing what is already on offer. A commissioning approach has been used in a number of settings globally within and outside the health sector for around 20 years.

The North Coast Primary Health Network (NCPHN) has created a framework for planning and commissioning work informed by recent literature and experience. All commissioning

tions regarding the reasons for poor health outcomes in communities.

3. Community Survey & Clinician Survey - the key themes identified within the focus groups will form questions which will be included in a Community Survey and a Clinician Survey 4. Mapping - a desktop mapping exercise will be completed, focussing on mapping the health workforce. conducted by NCPHN will aim to contribute to two objectives: • Increase efficiency and effectiveness of medical services, particularly for patients at risk of poor health outcomes.

• Improve coordination of care to ensure patients receive the right care in the right place at the right time.

The four key elements of the framework are: i. Needs Assessment

Get Connected Forum

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f you’re an allied health professional, you shouldn’t miss coming to The Let’s Get Connected conference and dinner is at Opal Cove Resort, Coffs Harbour on March 5 and 6, 2016.

It’s organised by the North Coast Allied Health Association (NCAHA), a not for profit organisation designed to give allied health practitioners a single voice and provide networking and referral opportunities.

Come and hear experts discuss the future direction of allied health and health 4

care integration. Keynote speakers include Prof Kathryn Refshauge, Dr Teresa Anderson and Prof Susan Nancarrow. Chair NCAHA. If you enrol with the NCAHA beforehand, you’ll receive a substantial discount for the seminar and if you register by 31 December, you go into the draw for a night’s accommodation at Opal Cove.

Join the NCAHA here: http:// ncaha.org.au/membership/ Register for the event here: www.amsn.com.au/events

ii. Planning iii. Procurement and Delivery iv. Monitoring & Evaluation Needs Assessment

This focuses on the identification and response to health needs in a local population. It involves access to and analysis of health informatics, including quantitative and qualitative data, market factors, workforce capacity and service gaps.

PHN Needs Assessments will be completed by the end of March 2016. The Department of Health has identified six priority areas – mental health, Aboriginal and Torres Strait Islander health, population health, health workforce, eHealth and aged care.

NCPHN has identified four strategies to implement this first Needs Assessment.

1. Analysis of Population Statistics - by early December 2015 an analysis of North Coast NSW geography, demography, health determinants, health status and behaviours, populations with special needs and individuals and groups at risk of poor health outcomes will be produced.

2. Community Focus Groups & Clinician Interviews – by mid-January 2016, 12 community focus groups (one in each LGA) and 24 clinician interviews will be completed to identify percep-

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Planning

Building from what is identified through an in depth Needs Assessment, the planning phase is heavily reliant on strong stakeholder relationships, innovation and the co-designing of services that result in a common vision.

Procurement and delivery

With a clear understanding of needs, service gaps and the development of a robust plan, attention will be given to the alignment of funding with population needs. Selecting the right mechanism requires focusing on the outcome and selection of effective, efficient and economic use of available health resources.

Monitoring and evaluation

Ongoing monitoring and evaluation of services is integral to improving quality and health outcomes. Sources such as patient feedback, complaint and incident management, performance and outcome data, provider review and service quality assessments are used to provide a reasonable picture of progress towards outcomes. This aspect of the process informs planning for future services commissioning.

All clinicians, community members and other stakeholders are invited to contribute to the Needs Assessment process. To find out how you can become involved, email commissioning@ ncphn.org.au.

healthspeak Summer 2016

Mental Health Plan launched

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n October 27, the Northern NSW Mental Health Integration Plan (MHIP) was officially launched in Lismore at Invercauld House.

The MHIP was a joint project

by North Coast Primary Health Network and Northern NSW Local Health District and came out of national and state reviews which confirmed the need for improvements in Australia’s mental health system.

In particular it was noted that without improvements, people engaging with the system would continue to experience unfulfilled potential in terms of both wellbeing and making a meaningful contribution to their communities.

The MHIP was developed in partnership with regional leaders and extensive consultation was carried out with mental health agencies, peers, carers and consumers.

The new plan outlines objec-

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Attendees at the Northern NSW Mental Health Plan launch.

tives, strategies, and actions to ensure that local health services are integrated, person-centred, seamless, effective and efficient.

It offers a vision for the future: “People and communities with mental health concerns are on a seamless journey of recovery, toward lives characterised by meaning, connection and contribution, served by a network of integrated, coordinated

and collaborative care.”

The new plan also acknowledges the challenges that a fragmented system is causing for Northern NSW. It recognises that we need to build the system around the person, and that this can only be achieved through collaborative action. Agencies must walk this path together with patience, commitment, trust and perseverance.

GP related data – NHPA update

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he National Health Performance Authority has released a report on GP and specialist attendances and expenditure in 2013–14. This health care data includes the average number of GP and specialists attendances across Primary Health Network (PHN) areas and associated costs.

Here is a summary snapshot of local health use in North Coast (NC) NSW. GP attendance and cost

• 3rd highest rating among PHNs for patients seeing a GP when need presented.

• Highest GP attendance rates. 86% of North Coast adults saw a GP in 2013/14 • Highest GP visits – each NC adult visited a GP 6.3 times (suggests link with chronic disease and aging) • 9th highest bulk-billed GP attendances with 85.9% bulk-billed

After Hours and Cost

• 8th lowest After Hours attendance rates – 0.19% • 5th Highest Expenditure on After Hours attendance - $316.28 per adult • 7th lowest MBS expenditure on After Summer 2016 healthspeak

STOP PRESS – Bigger role for PHNs in mental health

Hours - $11 per NC adult

Emergency visit patterns

• 7th highest with 18% of adults visiting ED

Hospital admissions

• 1 in 7 adults (14%) admitted to hospital in 2013/14

Specialist attendance

• 10th highest attendance rates (38%) • 8th highest expenditure with $82.72 spent on Medicare benefits per adult

Vaccination

• Low vax rate with 63% of girls under 15 having all three HPV vaccinations

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ust as HealthSpeak went to press, the Federal Government announced a major overhaul of mental health services, saying it was abandoning the current ‘onesize-fits-all’ approach.

The structural reform follows a review by the National Mental Health Commission into whether existing services were effective.

“We are setting out a blueprint for reform that puts the individual at the centre of our mental health system,” said Prime Minister Malcolm Turnbull.

Federal Health Minister Sussan Ley said that services needed to move away from Canberra and instead be designed at a local level for the different communities that need services.

“What we are moving to is regional commissioning, informed by the needs of the consumers in those regions - service delivery that matches what you receive as a consumer with what you need according to that level of need.”

This commissioning will be the task of Primary Health Networks and Ms Ley said that $350 million would be redirected from Canberra to PHNs for commissioning projects.

The Health Minister said the new approach would better support Australians to receive the most appropriate mental health care first time, when and where they need it.

The changes will see: • Care packages created for people with complex needs • A new digital gateway to online mental health services • A new single telephone hotline to direct people to appropriate services.

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Coffs Harbour community Ice Forum

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he highly successful Coffs Harbour ICE Forum held at the Norm Jordan Pavilion in October and organised by North Coast Primary Health Network, followed a community meeting about the issue in July at Wongala Estate. This meeting was called due to escalating community concerns about the drug ICE infiltrating the Coffs Harbour Aboriginal community.

In response to outcomes from the community meeting, the Indigenous Health project officer in North Coast Primary Health Network’s Closing the Gap team engaged the Gumbayngirr Youth Community Drug Action Team, Galambila Aboriginal Health Service and Junaa Buwa (Mission Australia) in a collaborative effort to plan the ICE Forum.

Relevant stakeholders were approached to ensure the content of the forum reflected community, client, and service needs.

A sensitive process was then

The Forum attracted more than 130 community members.

undertaken to interview a person with an ICE addiction. This courageous individual agreed to be filmed while sharing thoughts around the personal situations leading to the use of ICE. This person also offered a broader perspective by speaking about the current environment of drug dealers.

This fascinating film was screened during the forum which attracted 133 community members, 107 being

service representatives. Speakers included Senior Constable Dave Fish from NSW Police; Dr Lois Oliver from Galambila Aboriginal Health Service, Youth AOD Outreach Worker Josh Dooner, AOD worker Troy Como from Casino AMS and NCPHN Crystal Meth Program Officers Kim Gussy and Sam Booker.

There was also time devoted to group discussion on topics of particular interest.

Particular concerns or needs

that arose from the Forum include: • The need for culturally specific and culturally appropriate services such as Expert Trauma Informed Care for the Aboriginal community, • Increased funding to support community based recovery • The need for holistic care rather than the current silos of Mental Health and Alcohol and Other Drugs.

• The need for health worker education around ICE to ensure personal safety when around people under the influence of the drug • AOD Counselling to be located within the community rather than at hospitals The NSW Government has announced new dedicated ice rehabilitation clinics would be opened around the state, but a project tipped for the North Coast is yet to go to tender.

Clinical editors boost HealthPathways

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he HealthPathways team has been working hard to build the number of localised topics so that clinicians are likely to find relevant local content when they delve into the web site during a consultation. In mid-November there were 150 topics/ service directory pages completed and up on the website.

In recent months the team has been significantly boosted by the work of Dr Tim Peacock who works at Tintenbar Medical Centre and also as a VMO at Ballina Hospital. Tim brings a strong interest in evidencebased health care and has been leading development of topics on cognitive decline, diabetes and renal medicine as a Clinical Editor.

Dr Brenda Rattray joined our team in Port Macquarie as 6

Dr Brenda Rattray

a Clinical Editor some months earlier and has also created a surge of activity from Mid North Coast work groups – specifically cardiology, musculoskeletal and paediatric topics. Brenda also brings years of local experience as a GP and working as a VMO at Port Macquarie Hospital.

We now have work groups on the Mid North Coast developing topics on: cardiology -

Dr Tim Peacock

atrial fibrillation, heart failure, acute chest pain and on paediatric topics – ADHD, behavioural problems in children, autism spectrum disorder as well as prostate cancer.

Work groups in Northern NSW are localising a range of HealthPathways topics on cognitive impairment, psychosis, anti-psychotic Depot medication; haematuria, alcoholrelated pathways and antenatal

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shared care.

There have been a number of topics the HealthPathways team has been able to adopt from other regions with minimal change in a process we call ‘rapid localisation’.

Through this process we recently introduced a suite of HealthPathways topics on anticoagulation, (warfarin and NOACs) that will guide GPs through warfarin adjustments, overdose, choice of NOAC, management for procedures etc.

To view the Mid and North Coat HealthPathways localised for our region, visit the HealthPathways website at: http://manc.healthpathways. org.au – The username for the website is manchealth and the password is conn3ct3d

healthspeak Summer 2016

NCGPT to close after 13 successful years

By John Langill, CEO, NCGPT

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ince its inception in 2002, North Coast GP Training (NCGPT) has been a highly regarded and sought after provider of general practice training to GP registrars, prevocational doctors and overseas trained doctors. The high quality training delivered by an experienced and committed team meant that NCGPT could offer an innovative education program that met both the professional and personal needs of trainees. This all came at a time when GP numbers were falling in regional areas.

Back in 2002, the retention of doctors in regional areas was the catalyst for the establishment of providers like NCGPT. NCGPT has undoubtedly achieved this goal and we’re proud of the many graduates serving communities from Port Macquarie to Tweed

Heads.

NCGPT has had over 640 registrars on the books. In the early years, many registrars came to the region for mandatory rural rotations. However, as time went on, more and more undertook all of their training in the region. Of those who completed their training locally, 60% of them now call the North Coast home.

NCGPT started with a staff of three in a two-room office in Lennox Heads. In their first year, 48 registrars came through the training program. NCGPT’s popularity and success continued to grow and in 2015 they had a staff of nearly 40, with 116 practices, 206 supervisors and 159 registrars enrolled.

Although one of the smaller providers, NCGPT has punched above its weight. Over the years, NCGPT and its staff, registrars and supervisors have won 21 national industry awards. In

the last five years alone, that included two Medical Educators of the Year, two Supervisors of the Year, two Registrars of the Year and two Rural Registrars of the Year.

Innovative face to face training with a focus on doctors’ wellbeing quickly became nationally, and internationally recognised and placed NCGPT educators on the conference circuit. NCGPT registrars and supervisors have long been active in national general practice organization and are helping shape the future through their roles on many Boards and committees.

These are outstanding achievements and a testament of the commitment to quality training by passionate staff, GP supervisors and training practices.

The 2014 Federal budget flagged structural reform of the Australian General Practice Training program. In NSW it

meant the six existing providers would be reduced to three.

After careful consideration, NCGPT collaborated with colleagues at GP Training Valley to Coast (Newcastle/Hunter) and WentWest (Western Sydney) to tender to run the training program in the North Eastern NSW training region. This large region went from North Sydney to the Queensland border and west to Moree.

Despite months of tireless work and consultation, the support of critical stakeholders and references from a myriad of training practices and GP supervisors the tender was not successful. Sydney based provider GP Synergy secured all three regions across NSW. Although bitterly disappointed, NCGPT is committed to working with GP Synergy to ensure a smooth transition

Continued page 10

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Summer 2016 healthspeak

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Meet NCPHN’s GP advisers North Coast Primary Health Network (NCPHN) has employed five GPs across its footprint one day a week to advise the PHN on a range of topics and to facilitate GP engagement across a range of activities.

These doctors will also assist the NCPHN’s new Clinical Councils and provide advice on clinical governance and professional development matters.

great community, and is looking forward to conversations with NCPHN staff.

Dr Gull Herzberg, Coffs Harbour

Dr Marion Tait, Lismore/ Ballina

For Marion, growing up in a rural medical family meant that dinner conversation was always interesting. She describes it as ‘a slow maturing of a very tough constitution for discussing lots of gory things while eating delicious food!’

It is no surprise then that after school, Marion decided Oceanography / Meteorology was how best she could serve humankind.

Her greatest scientific contribution to the world was to do with the formation of Antarctic Bottom Water (yes there is such a thing!), but she said she just didn’t have enough facial hair to continue down this stream.

And so to Medicine - Marion completed a post-grad course in its infancy at Flinders University. After two years of city living she felt a desperate need to be somewhere smaller, and finished her degree in the Northern Territory. She has also been privileged to work for North Coast GP Training as a registrar, board director, medical educator and supervisor.

Marion ‘absolutely loves’ her work at Casino AMS, working with a fabulous team for a 8

Dr Brett Lynam, Tweed Heads

Gull completed his BSc(Hons) at UWA in 1986. He lived, worked and travelled overseas for a decade before returning to Australia and doing his medical training in the Graduate Medical Program at Sydney University.

He lives and works as a GP in Bellingen. He has a strong interest in systems improvement, from the level of the individual GP, through the practice and up to regional and beyond. He has always had a keen sense of how people can work better together.

He has clinical experience in rural and metropolitan hospitals, mental heath and aged care facilities, palliative care and youth health.

Gull was integral in developing and implementing a system of improved care for residents and staff in aged care facilities now in place in some RACFs on the Mid North Coast. He was the initial headspace GP in Bellingen and is now on the team at Bellingen’s Youth Hub Clinic.

His clinical interests include youth health, mental health and Integrative Medicine. He is particularly keen to hear from and work with any or all interested GPs and others involved in primary health care. He looks forward to helping to improve the health of our community through his work with NCPHN and would welcome ideas and suggestions. Email: gherzberg@ ncphn.org.au

Brett has 30 years experience working across primary health care domestically and abroad.

He has worked in rural and remote Northern Queensland and has a special interest in Aboriginal health. Brett also has strong expertise in public health and worked as a Senior Medical Officer in community-based vaccination programs, services for the disabled and elderly, integration of Community Health and hospital programs. In addition he worked as an Associate Lecturer for the Royal College of Surgeons in Ireland where he lived for 12 years.

Brett now works in a busy general practice in Tweed Heads and is dealing with the challenges of NSW/Qld border practice. He’s enthusiastic about improving health care outcomes through integration and better coordination of health services.

A keen cyclist, when Brett’s not working you will find him in the hills on two wheels, enjoying the beautiful North Coast.

Dr Dan Ewald, lead Clinical Adviser

Dan is a GP and public health physician working in general practice at Lennox Head and

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at Bullinah Aboriginal Health Service in Ballina since 2003.

He was director, then chair of General Practice NSW which became Networking Health NSW from 2010 to 2015.

Dan is an Adjunct Associate Professor, Sydney University at the University Centre for Rural Health and a graduate of the Australian Institute of Company Directors training program. Current health service and research areas of interest include the patient-centred medical home, paying for quality in primary care, low-intensity mental health services, Aboriginal health, hospital avoidance and development of HealthPathways.

Publications can be viewed at http://www.researchgate.net/ profile/Dan_Ewald.

He also plays bass in El Scorcho, a rock band that you will not have heard of.

Dr Paul Davies, Tweed Heads

Paul hails from Tasmania where he completed his medical degree in Hobart in the mid 1970s. He then worked at Royal Brisbane Hospital until 1980 when he moved to the Tweed region.

He’s been working as a GP in Tweed Heads ever since.

He is much loved by patients at Fred’s Place homeless support service run by NCPHN where Paul works at the GP clinic.

He also works at Bugalwena General Practice and headspace Tweed Heads.

Paul describes his interests as ‘wiping out’ his lifestyle diseases, football, and hopefully travel in the future.

healthspeak Summer 2016

Tresillian helping families

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n mid-November the official opening was held of the new Tresillian Family Care Centre in Lismore.

The opening by Karen Hogan, wife of the Federal Member for Page, coincided with NSW Perinatal Depression and Anxiety Week. Tresillian’s Operational Nurse Manager, Rural Services, Debbie Stockton said it was not unexpected for parents to find the lack of sleep and stress of a crying baby impacting on their mood and ability to cope.

“Our nurses are able to identify and support parents who are at risk of or are experiencing postnatal depression and anxiety, so the family can receive

the help they need as early as possible.”

“The Tresillian Centre in Lismore provides a range of services and programs to help parents with the challenges of an unsettled baby, while importantly focusing on the emotional wellbeing of the family as a whole,” said Ms Stockton.

Tresillian’s management of the former Northern Rivers Family Care Centre came about through an agreement with North Coast Primary Health Network and the Northern NSW Local Health District. Both organisations will provide support to the centre over the next three years.

The entry of Tresillian into

Ending violence against women

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he White Ribbon Campaign is the first male led violence against women prevention campaign in Australia and is held on 25 November annually.

This year to mark White Ribbon Day, North Coast Primary Health Network, in collaboration with the Northern NSW Local Health District (NNSWLHD) held a domestic violence information session for medical practitioners and health workers at Crawford House in Lismore.

The event was hosted by Wayne Jones, Chief of Staff at the NNSW LHD, and informed clinicians about resources and services available in Northern NSW to support women and children who may be affected by domestic violence.

White Ribbon Day ambassador Patrick Deegan, from the Far North Coast Family Referral Service, was a guest speaker at the event and highlighted the impact of domestic violence in the community and the positive role men can play to break the cycle of violence. Other speakers and panel members at the event included Tara Woods, DV Liaison Officer at NSW Police; Ellie Saberi, Women’s and Child Summer 2016 healthspeak

From left NCPHN Acting CEO Michael Carter, NNSWLHD Chief of Staff Wayne Jones, and Tresillian CEO Robert Mills at the opening.

Lismore means that the wonderful service provided for parents of children up to 12 months of age will be supported by Tresillian experts and clients will receive much needed expert advice on settling their baby, breastfeeding issues and dealing with anxiety and depression.

At the opening, Tresillian Council President Dr Nick Kowalenko said it was well docu-

mented how effective Tresillian service was when it came to supporting new parents.

“We’re pleased that families in the Lismore region will have access to Tresillian’s early parenting services without having to travel to Sydney.”

Tresillian is at 46 Uralba Street, Lismore. Phone them on 6622 8705.

LOOKING FOR SOME NEW WHEELS?

Health Program Coordinator at the NNSW LHD; and Sandra Handley, Manager at the Lismore Women’s Health and Resource Centre.

Reflecting the horrific effect that domestic and family violence is having on our community, Tara Woods highlighted that during 2015, two women a week were reported to have been killed by partners or ex-partners in Australia. The panel also spoke about the importance of a coordinated, interagency response to support those affected by domestic and family violence and the importance of GPs playing a leading role in supporting survivors.

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SOUTHSIDE HEALTH & HIRE CENTRE Call us today on (02) 6621 4440 or come in and say hello at 5 Casino Street, South Lismore.

Southside Health & Hire Centre Where your health is our total concern.

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9

RN students shine in general practice

S

outhern Cross University is planning its primary care nurse placements into general practice for 2016 and is keen to hear from general practices willing to take on final year nursing students.

SCU’s Clinical Nursing Leader Ross O’Neill said nursing students were required to do a number of placements during their training and many were keen to do a second placement in general practice at the end of their study.

“Our students who undertake a four-week placement in general practice generally find it a great experience and we’ve had good feedback from the practice staff about the students they’ve mentored,” he said.

Tweed Super Clinic Health for Everyone’s Nursing Manager Tara Cahill told HealthSpeak

Tweed Super Clinic’s Nursing Manager Tara Cahill

that the two final year nursing students who did four-week placements at the Super Clinic not long ago were a real asset to the clinic, and because they were close to completing their degrees were ‘just like another pair of hands’.

Tara said she really enjoyed passing on her knowledge and because the Super Clinic had

plenty of space the nurses were able to work in different parts of the facility – in the skin clinic, the wound clinic and the treatment rooms.

She said it was particularly beneficial for the students to work as part of a team and to understand how the care of patients continued when they were discharged from hospital and came under the care of nurses in the wound care clinic, for example.

“I guess some general practices without a lot of space might find it easier to take on just one student, but I’d certainly recommend that other practices on the North Coast consider taking on a student nurse next year,” she said.

One of Tara’s students, Diana Reynolds told HealthSpeak that the Super Clinic placement was the most rewarding she’d done

Scholarship enhances RN’s careers

R

egistered nurse Sara Delaney is delighted to have been a recipient of a Healthy Living with Diabetes Scholarship, enabling her to study to become a Credentialed Diabetes Educator.

Sara was one of four nurses who were assisted by North Coast Primary Health Network to upskill in the area of diabetes through the scholarship program.

The scholarship helped Sara with university costs to allow her to pursue an Accredited Post Graduate Certificate in Diabetes Education through Southern Cross University, a course recognised by the Australian Diabetes Educators Association.

“The scholarship for the year of study assisted me greatly,” said Sara.

“Diabetes is a huge issue with 280 people diagnosed every day - that’s one every five minutes.

Working in general practice as a Registered Nurse I see the complications of diabetes every day. I felt that the course would help me teach my patients how to 10

Sara is enjoying her clinical placement following her studies at Coffs Harbour Health Campus.

manage their diabetes and therefore reduce their complications.”

Sara said she’d learnt a lot about diabetes and was reciving great feedback from her patients.

“I am now eager to run short information sessions for my patients. There is no cure for diabetes but it is an entirely manageable disease and that’s where my focus is - teaching people to manage their diabetes and get the most out of their lives.

“It’s important to spend time with patients teaching them

about eating a healthy diet, and getting some exercise. But also how to give themselves insulin and increase or decrease their dose,” she added.

Sara said she’d recommend the Graduate Certificate in Diabetes Education to other RNs as more and more Diabetes Educators will be needed in general practice.

She is now enjoying her clinical placement at Coffs Harbour Health Campus, helping patients to make lasting positive health changes in their lives.

a publication of North Coast Primary Health Network

and that she learned a great deal, which meant her confidence went to a higher level.

“I also learnt about building therapeutic relationships with clients through my time at the wound care clinic. Wound care nurse Gerard Robards is a wonderful teacher.

“I also learnt about building therapeutic relationships with clients through my time at the wound care clinic. Wound care nurse Gerard Robards is a wonderful teacher and I enjoyed finding a rapport with the patients who would come in regularly and were very appreciate of our skills,” said Diana.

If your general practice is interested in placing a nursing student, contact Michael Grande at: michael.grande@scu.edu.au or phone him on 0447 624 472.

From page 7

with minimal disruption to registrars and training practices. GP Synergy will assume responsibility for the training program on 1 January 2016. It’s hoped some NCGPT staff will transition to GP Synergy and continue our legacy of quality.

As NCGPT prepares to close its doors, staff will reflect on the real difference they have made in our region. NCGPT is proud of its many achievements over the past 13 years and would like to thank every doctor that entrusted their training to them. NCGPT also extends heartfelt appreciation and thanks to all the training practices and GP supervisors who shared NCGPT’s passion for teaching. Without them there is no general practice training.

healthspeak Summer 2016

Video conferencing for cancer patients

T

he Mid North Coast and Northern NSW Cancer Institutes are led by Area Director of Cancer Services, A/Prof Tom Shakespeare, and have centres in Port Macquarie, Coffs Harbour, Lismore and Tweed Heads. Together they service a population from Forster in the south to the NSW / QLD border and as far west as Coonabarabran.

Some patients find it difficult to attend clinic appointments in person for reasons including: • Travel distance • Modified drivers’ licences • Carer responsibilities • Mobility issues In order to address patient needs, the Cancer Institutes are implementing video conferencing-based online appointments.

The project team is also aiming to deliver additional benefits for primary care providers through better engagement with specialists and greater involvement in the patient’s ongoing care planning and delivery. This will improve long-term care coordination and the hope is that this, in turn, will improve overall patient care.

The project uses a computer program called Microsoft Lync to conduct the video conferencing. This program is of no cost to practices or patients; can be used on almost any computer or device; has the ability to connect almost anywhere and provides high levels of security.

The model of care being

A/Prof Tom Shakespeare with radiation therapist Bruce Ha

Appointment Time

Standard Code

Standard MBS Rebate

Telehealth Code

Telehealth Rebate

Short

3

$16.95

2100

$22.90

Less than 20mins

23

$37.05

2126

$49.95

At least 20mins

36

$71.70

2143

$96.35

At least 40mins

44

$105.55

2195

$142.50

implemented involves the patient attending an appointment with their GP during which time the GP undertakes the necessary physical examinations. The two doctors and the patient then participate in a joint discussion and coordinate the plan for future care. This does present some challenges in terms of scheduling appointments, but so far the project team has made this work for everyone involved.

Patient feedback has been positive with regards to time and effort saved, as well as having both doctors in attendance.

Patient comments include: “I

saved on time and travel” and “Super convenient and saved the travel to Coffs Harbour” Access to the online appointments is being managed through emails on a case-by-case basis.

Work is underway on login gateways via the Local Health Districts’ public websites which will simplify and standardise the process for everyone involved.

GPs and Practice Managers may like to note that there are a number of telehealth-specific Medicare rebate item numbers for these types of appointments, and that all these rebates are at a higher level than the corre-

sponding time-based rebates for normal face-to-face appointments.

The information on the table at left came from http:// www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/ Content/Home and was correct at 13/10/2015. It should be confirmed for accuracy.

To streamline the appointment process for future patients, the project team are hoping to get the software set up at as many North Coast practices as they can. Once the initial set up is complete, the program can then be used for clinical appointments with no further installation requirements. There may also be opportunities to use the program to connect with the MNCLHD or the NNSWLHD for other clinical purposes such as MDTs or non-clinical activities such as education sessions.

The Cancer Institute will be contacting practices soon. For further information, contact Ben Hodgson, Project Officer, on 0438 841 199 or email ben. hodgson@ncahs.health.nsw. gov.au

View past issues Did you know you can read HealthSpeak online?

Go to www.issuu.com/healthspeak and see all 14 issues.

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11

Building Partnerships around aged care

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uilding Partnerships is a two- year project supported by the Agency for Clinical Innovation (ACI).

This program focuses upon improving and integrating health for aged persons with complex needs. The project works under an interagency steering group that collaborates to further develop interagency partnerships and support the implementation of good practice models.

In all 13 teams across NSW are participating in ACI’s Capability Development Program, each with its own project. The Tweed team has commenced investigating ‘Reduction of Prolonged Exposure Risk in Aged Persons at the Tweed Hospital Emergency Department (TTH ED).

The Tweed Building Partnerships team consists of Project Lead Bill Sexton, Manager ACAT; Lisa Garland, Nurse Practitioner Aged Care The Tweed Hospital (Clinical Lead); Diana Anderson, Project Officer North Coast Primary Health Network and Gretel Jones Project Officer Building Partnerships Murwillumbah Hospital.

Catriona Wilson, NNSW LHD

The Building Partnerships Project Team – from left: Bill Sexton, Manager Tweed ACAT, Diana Anderson Project Officer NCPHN, Gretel Jones Project Officer Murwillumbah District Hospital and Lisa Garland Nurse Practitioner Aged Care, The Tweed Hospital.

Manager of the Integrated Care Collaborative is also a project member. Other consulting partners come from the Tweed GP Collaborative - they are Alzheimers Australia, Hammond Care/DBMAS and Tweed Shire Council Community Services Tweed Heads.

The participating teams have been supported by workshops at ACI Chatswood. During the workshops a range of topics were presented by the Ministry of Health, Paramedic Response

Network NSW Ambulance, and experts from ACI including Liz Hay Program Manager, Health Economics Evaluation Team, ACI Lismore Office.

During the course of the project ACI keep in touch via email, teleconferences, Basecamp and face to face. They continue to support the team’s learning and development through monthly webinars and the team is given eight hours of personalised coaching.

Residential Aged Care Facility

(RACF) residents potentially experience delays after treatment at Tweed Hospital Emergency Department has finished. Research has found that waiting in unfamiliar environments exposes residents to risks such as delirium, pressure areas, falls and hospital acquired infection. The project is investigating the nature of the delays (possibly transport, medication dispensing or RACF acceptance hours), and whether these are these reasonable? It also looks at the reason for the delays and what can be done to reduce them.

As part of the diagnostic phase the project is consulting with stakeholders TTH ED, The Tweed Heads Pharmacy, NSW Ambulance, Queensland Ambulance, Patient Vehicle Transport Service and Northern NSW and SE QLD RACFs. Consumer input is coming from personal interviews with RACF residents recently returned from TTH ED. The project‘s diagnostic phase is nearing completion and the larger project will commence in early 2016, with completion by early 2017 and the final report due mid 2017.

New reports now available in The Canning Tool

A

new update of The Canning Tool has been completed with additional reports now available for use by health services.

The update includes easy to read reports in Osteoporosis and Indigenous primary health care national key performance indicators. Patient lists for each report are available – with the ability to link to patient records in your clinical information system, and export lists to Excel.

Osteoporosis Report

The new Osteoporosis report provides measures including: • Number of clients on the Osteoporosis register • Proportion of clients aged 12

50 years and over with Osteoporosis who have had one or more fractures within the previous 12 months • Proportion of clients aged 50 years and over with Osteoporosis who have had one or more fractures and have a GP Management Plan or Team Care Arrangement (MBS item 721, 723, 729, 731 or 732) claimed within the past 12 months • Proportion of clients aged 50 years and over with Osteoporosis who have had one or more fractures currently prescribed an osteoporotic pharmaco-

therapy agent Details on the relevant patients and data fields can be viewed and exported to Excel.

Indigenous Health Care

The 24 Indigenous primary health care national key performance indicators are now also available. These measures cover a range of indicators for clear visibility on your clients’ health.

They include: • Number of regular clients for whom an MBS Health Assessment for Aboriginal and Torres Strait Islander People (MBS Item 715) was claimed • Number of Indigenous children who are fully im-

a publication of North Coast Primary Health Network

munised • Number of regular clients with a chronic disease for whom a GP Management Plan (MBS Item 721) was claimed • Number of regular clients whose smoking status has been recorded • Number of regular clients with a chronic disease with a Team Care Arrangement (MBS Item 723) The Canning Tool will continue to undergo further functional enhancements.

For any feedback or information on The Canning Tool project email qi@ncphn.org.au. healthspeak Summer 2016

December 3 is International Day of People with Disability.

HealthSpeak felt it was timely to write an article to help GPs and other health professionals best care for people with intellectual disability.

C

ognitive and communication issues can make it difficult for people with intellectual disability to recognise and communicate pain, discomfort or other symptoms of ill health.

As a result, family members or support workers are often relied upon to bring health problems to the attention of the GP and to provide a medical history.

However, these people may also be unaware of symptoms, and with a turnover in support staff an accurate history may be hard to obtain.

In addition, a physical examination may be difficult due to anxiety or challenging behaviours. These factors may mean that assessments can be lengthy.

The NSW Department of Health has published some useful guidelines for GPs compiled by the Centre for Developmental Disability Studies at the University of Sydney. HealthSpeak has used these as a basis for this article and spoken to disability support workers for advice on how GPs can provide the best health care for people with intellectual disability.

Health Status

Research shows that people with intellectual disability tend to have • A higher level morbidity than the general population, often with complex, multiple, chronic health problems • a higher prevalence of certain conditions, as well as life style related health such as obesity and poor fitness .

Summer 2016 healthspeak

A higher level morbidity than the general population, often with complex, multiple, chronic health problems

They are also less likely to be offered preventative health measures such as blood pressure screening, cancer screening and immunisations. And there is also the problem of ‘diagnostic overshadowing’ – where clinicians may ascribe physical or behavioural symptoms to the intellectual disability, and not look for associated physical or mental health disorders. This can lead to conditions being overlooked.

Common health problems Respiratory illness Vision impairment Hearing impairment Oral health problems Nutrition problems Gastro-oesophageal reflux disease and helicobacter pylori infection Constipation Epilepsy Mental health problems Thyroid disease Osteoporosis, osteopenia Obesity and poor fitness Genetic disorders Polypharmacy

Evaluation & Treatment recommendations Oral Health – ensure annual

dental examinations, more frequently if problems are present Vision – Ophthalmological

assessment every five years from age 45; an extra assessment at 30 years for people with Down syndrome. For those with existing problems, more frequent reviews may be necessary.

Hearing – Routine audiological

assessment every 5 years from age 45 years; for people with Down syndrome, assessment every 3 years throughout life.

Nutrition risk – Screening

annually or more frequently if indicated. Those underweight or with dysphagia should be referred for a multidisciplinary assessment that includes evaluation by a speech pathologist and dietitian.

Constipation – Constipation

can have serious consequences such as megacolon and perforation. Treat proactively with diet and medications.

a publication of North Coast Primary Health Network

Epilepsy – Those with epilepsy

should have regular assessment of seizure frequency, anticonvulsant therapy (with serum levels as indicated). An epilepsy management plan should be in place and review by a neurologist at least annually is recommended.

Thyroid disease – Symptoms

may be non-specific and insidious. Both hypothyroidism and hyperthyroidism are common.

Consider thyroid disease in those with behavioural or mood changes. Annual thyroid function tests are recommended for Down syndrome, or those with existing thyroid disease. For all others who are not symptomatic, thyroid function tests are recommended every 3-5 years.

Gastro-oesophageal reflux disease (GORD) – Often goes

unrecognised in people with severe intellectual disability.

Typical symptoms of vomiting and retrosternal pain may not be present, but may refuse to eat, have agitation and distress during or after meals, self-injurious behaviour, night time coughing, dental erosions, iron deficiency anaemia, or weight loss. For 13

Feature

Intellectual disability: Ensuring optimal health care

Mental health disorders are common and may present in an atypical manner.

ment of associated health problems. A diagnosis can also have an impact on the individual’s family, and genetic counselling may be required. A genetic assessment should be considered in all adults without a diagnosis for their intellectual disability.

Women’s health – Recom-

those without alarm symptoms, a therapeutic trial of a proton pump inhibitor is reasonable. If alarm symptoms are present (eg weight loss, haematemesis, or anaemia), endoscopy is required.

Helicobacter pylori infection

Feature Intellectual disability: Ensuring optimal health care

– Common, especially in those in large residential care facilities.

Sequelae of h.pylori infection include gastritis, peptic ulcer and gastric cancer, but people with intellectual disability may not be able to complain of pain.

Therefore screening recommended for high risk individuals.

If patient can’t do the diagnostic urea breath test, an alternative is the h.pylori serology and treat if positive. Test for eradication with faecal antigen test.

Osteopoenia/Osteoporosis –

Risk factors include hypogonadism, immobility, underweight, presence of Down syndrome and vitamin D deficiency. Baseline Bone Mineral Density should be considered in all adults with intellectual disability, especially in those with risk factors, or a history of minimal trauma fracture. Risk factors should be treated where possible, and appropriate therapy for osteoporosis instituted (eg testosterone/ oestrogen replacement therapy, bisphophonates). Give advice on falls prevention measures.

Annual vitamin D and calcium levels are recommended in those with inadequate sun exposure, multiple anticonvulsant therapy or malabsorption. Vitamin D and calcium supplements are indicated in those with low levels.

Medication review – Poly-

pharmacy is common with its

14

attendant risks of side effects and drug interactions. Review all medications 3-6 monthly: Immunisations – NHMRC

recommendations for immunisation schedules should be followed.

Hepatitis A immunisation is recommended for all people with intellectual disability, and Hepatitis B immunisation is recommended for those in residential or non-residential facilities. Annual influenza and

mendations as for the general population. Note that women with intellectual disabilities are at increased risk of sexual assault. Where the Pap test is difficult to do and sedation may be required, the issues should be discussed with all concerned and the risks and benefits balanced.

Mental health problems, difficult behaviours – Mental health

disorders are common and may present in an atypical manner.

With behavioural changes, look for underlying physical health

Case study Frank is a person with severe intellectual disability. He presented with serious self-injurious behaviour, hitting the side of his face. The staff member accompanying Frank did not know him well. The doctor attributed his behaviour as being typical of someone with a severe intellectual disability. Frank was later found to have a dental abscess that had previously been missed.

5 yearly pneumococcal vaccines are recommended for those with chronic cardiac, renal or respiratory disease, or diabetes.

Physical activity – Many people

with intellectual disability have low levels of physical activity. At least 30 minutes a day of moderate intensity physical activity is recommended most days of the week. Group activities and incentives encourage participation.

For those with physical disabilities, activities can be modified.

An assessment by a physiotherapist or exercise physiologist might be useful.

problems (eg pain, discomfort, thyroid disease) or external factors (eg change of support staff, loss of family or friends due to death, illness or moving away). Further evaluation with behavioural assessment by a psychologist, and or referral to a psychiatrist may be required Dementia – People with Down

syndrome are at risk of early onset Alzheimer’s disease and might present with symptoms in their 40s or earlier. The differen-

tial diagnosis includes hypothyroidism, depression and sensory impairments, all of which are more common in people with Down syndrome. Dementia assessment tools designed for people with intellectual disability are available. Refer to an ACAT service, psychiatrist or adult developmental disability medical service for further evaluation.

Advice from support workers

HealthSpeak invited Disability Support Workers from Multitask in Lismore to provide advice and tips for GPs on supporting people with an intellectual disability.

Multitask Operations Manager Kim Davis said the support workers made three main points: 1. Speak to the patient first 2. Listen to the patient first 3. If the GP is unsure or having difficulty, then check in with the support worker/ family, but make sure the client is still included in the conversation.

Kim said some GPs can be frustrated by the amount of paperwork they are required to fill out for a patient with an intellectual disability. She said GPs are required to provide staff and patient with some or all of the following: • Consultation notes • To sign off on treatment plans • Identify risks and step out action plans • Provide a review process for patient’s needs • Ensure the support worker understands what’s occurred in the consultation • Provide allied health/specialist referrals with as much history as required for a professional consultation.

Genetics – Genetic causes

for intellectual disability are common. Even in an adult, the detection of a cause is important, allowing for proactive manage-

a publication of North Coast Primary Health Network

healthspeak Summer 2016

What is?

What is a radiation therapist?

Profile

R

adiation therapists use 3D and 4D imaging equipment and computer planning systems to create and calculate the best treatment for the patient as set out by the radiation oncologist. They deliver the radiotherapy after moving the patient into the treatment position that will provide the best coverage for their cancer while limiting the radiation delivered to normal, healthy tissue.

Stephen Manley – radiation therapist

I

t was during his final year of secondary school that Stephen happened to attend an Open Day at the Peter MacCallum (Peter Mac) Cancer Centre. This led to a week of work experience at the prestigious Melbourne cancer centre.

Stephen’s time at Peter Mac and other work experience in pathology helped him realise what he really enjoyed doing and he commenced his Bachelor of Applied Science in Medical Radiations Degree at RMIT. “Although I did enjoy the scientific investigation element of pathology, it was the combination of technology and patient care that swayed me towards radiation therapy,” he told HealthSpeak.

But Stephen has not stood still.

“Since attaining my degree in 1991 I have maintained the continuous learning philosophy and acquired a Graduate Diploma in Business, a Diploma of Project Management and am now working towards a Masters of Business Administration.”

His first radiation therapy position was at Peter Mac where he spent time in treatment and planning. Patient planning consisted of two-dimensional x-rays coupled with external contouring using lead wires to simulate a patient’s body dimensions and calculate dosimetry.

“There were two treatment

Summer 2016 healthspeak

planning workstations for the entire organisation (seven linear accelerators) and only one could calculate on CT images.

Nowadays we have treatment planning computer workstations on every staff member’s desk along with remote access to external PC’s, tablets and other devices,” he said.

Stephen then spent six years working at the Austin/ Repatriation Radiation Oncology Centre in Melbourne and completed a year of overseas travel working at Charing Cross Hospital in London before returning to Peter Mac as a senior radiation therapist co-leading the group responsible for breast and paediatric radiation therapy.

His work has given him a particular outlook on life.

“It is a sober reminder of how lucky most of us are when you spend time working with sick children and their families, but this period was also one of the most rewarding times in my life. Radiation therapy services were well and truly decentralising and my next role was part of the implementation

team for the Epworth Radiation Oncology service in 2001 where paperless workflow, image-guided treatment and public/private partnerships were commenced,” Stephen explained.

In 2008 it was time for a change in direction and Stephen spent two years as Senior Project Officer in the Cancer and Palliative Care section of the Victorian Department of Health.

“This was a great experience and allowed me to spend time in most of the cancer services across Victoria as well as expanding my knowledge of chemotherapy, cancer genetics, information technology, capital works planning and the machinations of government!

In 2010 I arrived in Lismore as the on-site manager for the soon to open North Coast Cancer Institute, Lismore Cancer Care and Haematology Unit and now work with a team of radiation oncologists, radiation therapists, medical physicists, nurses, allied health and administrative staff to provide radiation therapy services to the far North Coast and surrounds.”

Nowadays Stephen juggles the roles of radiation therapist and Cancer Systems Innovation Manager, blending his clinical and bureaucratic experience.

“In Lismore we provide radiation therapy services that are excellent, not just for a regional centre but on the

a publication of North Coast Primary Health Network

national stage. Our integration with radiation oncology centres in Coffs Harbour and Port Macquarie have allowed cross-fertilisation of skills and knowledge to ensure that the population of the North Coast has the services it advocated for over such a long period. The digital age and our application of it allow us to provide treatments that improve the outcomes and quality of life of our patients,” said Stephen.

He has no hesitation in recommending radiation therapy as a great career.

“It is a blend of patientcentred care working within a multidisciplinary team and cutting edge technology. Our patients regularly provide us with sincere and encouraging feedback that our service meets their needs and exceeds their expectations.

“There is the ability to travel both within Australia and overseas as a radiation therapist and many career avenues including research, management and advance practice. We hold an Open Day at Lismore each year and provide student placements for radiation therapy students from Newcastle and Queensland.

“As with most professions that have high patient contact the most rewarding part of the job is when you can see that you have made a difference to a person’s life whether it be fleeting or permanent.”

15

Grad Cert in Allergic Diseases

T

he rise in allergic disease over the last three decades has placed significant burden on healthcare systems to provide quality care to allergy sufferers. There is an urgent need for allergy specialisation in primary care to meet the demand in allergy treatment and reduce waiting times.

Offered through the University of Western Sydney, the Graduate Certificate in Allergic Diseases is designed for medical practitioners, particularly GPs and paediatricians who want to improve their care of patients with allergic diseases and gain a greater understanding of allergic

disease management. Entry is open to registered medical practitioners in Australia and New Zealand.

This two-year part-time course combines an introduction to the scientific basis of allergic diseases and clinical aspects of allergy. In the first year, students will complete a scientific program consisting of eight online modules delivered in distance mode, requiring about five hours study per week.

The second year consists of 50 hours of supervised clinical consultation within the setting of a specialist Immunology and Allergy clinic.

As part of the course, students attend a full day face-to-face workshop each year, the Australasian Society of Clinical Immunology and Allergy (ASCIA) Annual Conference in both years, and the Macarthur Series in Immunology in Year 2.

Indicative annual tuition fee for 2015 is $ 7,900.

All domestic applications for entry to UWS postgraduate courses must be made through the Universities Admissions Centre (UAC). Instructions are available on the How to Apply pages. To register your interest

and receive further course information, please email: s.sonego@ uws.edu.au Further information is available through the University of Western Sydney at: www.uws.edu.au

Learning to look beyond the disability

By Professor Iain Graham Dean, School of Health and Human Sciences Southern Cross University

I

n the autumn of 2015 the School of Health and Human Sciences was approached by senior colleagues from the RED Inc. service with a desire to build educational, research and clinical links between themselves and the School.

From this conversation a project of engagement has now grown to the satisfaction of all.

RED Inc. is an organisation that aims to provide young people living with disabilities with life skills after they leave school.

The engagement project with RED Inc. has two aims: 1. To develop, implement and evaluate stakeholders’ views of satisfaction with an inter professional student-led clinic on the premises of RED Inc., Lismore ,where SCU health students, under supervi-

16

sion, will undertake health checks on RED Inc. service users, their carers and staff.

2. To explore the educational value of this clinic with regard to the development of students’ inter professional and person centred health skills.

Over the past academic session students from the various health disciplines who read for their respective degrees at SCU, have provided health checks and wellbeing assessments of RED Inc. service users. This has resulted in advice being given about lifestyle issues such as exercise and nutrition, often with referral to various health professionals if needed. Students are guided by their supervisors during the consultation and screening and also learn good documentation skills as they progress.

The RED Inc. staff, Tim Stern, Bimbi Gray and Mei-meme, believe that this engagement, will create greater

interest in health issues among their service users who often won’t engage with health promotion/ education programs nor readily access traditional services for a range of reasons.

The benefits for the SCU students is realised by them seeing the uniqueness of the person often hidden behind the disability! This is an excellent learning experience for all health students who need to understand the importance of communication and its various techniques with all patients or clients.

This is a pilot project, trialling the methodology and supervision model. We are gath-

a publication of North Coast Primary Health Network

ering base line information about the service users and their needs to identify where future teams of students might gain experience - in essence a quality improvement cycle. In the end we hope to establish a permanent arrangement to our mutual benefit.

The project has ethics approval and the intended outcomes support the School’s community engagement plan in a number of ways.

We also seek to contribute to the scholarly literature and debate, concerning the health needs of this population, particularly given the introduction of the National Disability Insurance Scheme. We are also wishing to facilitate inter professional learning among the next generation of health workers.

At SCU we are seeking out partnerships such as this in order to achieve the goal of person-centred care across a range of populations by providing novel and creative professional learning experiences.

healthspeak Summer 2016

Student clinics boost public oral health care

A

range of oral health services is provided through the Northern NSW public health system and includes dental services to children and adults. Oral Health NNSWLHD accepts the Child Dental Benefit Scheme vouchers and does provide the full necessary treatment beyond the limitations of the vouchers.

Northern NSW Oral Health also offers comprehensive care to eligible patients at the student clinics at Tweed Heads and Ballina. A referral system is in place to the student facilities from the remaining public clinics. Services are available at Tweed, Pottsville, Mullumbimby, Ballina, Goonellabah, Casino, Nimbin, Maclean and Grafton.

To make an appointment, call the Customer Service Line on 1300 651 625. If you are eligible, you will be triaged and treated according to need. . The students primarily do comprehensive care of the patients requiring the most work.

The service is available to ALL children under 18 and to eligible adults. Adults must be 18 years of age or older, and hold or be listed on a Health Care Card, Pension Concession Card or Commonwealth Seniors Health Card.

Northern NSW LHD Oral Health Clinical Director Dr

Nanna Kreutzfeldt told HealthSpeak that while acute care takes up much of the clinical day, the service is offering comprehensive care to all patients receiving dentures before they are issued, as well as people off the general waiting list at both student facilities. The service is also trying to incorporate comprehensive care

From page 3

tion or service system, even the most `evidence-based’ treatment approaches may be compromised.”

(Saakvitne, 2000; Harris & Fallot, 2001) The fact that people who are long term unemployed often have high ACE scores reveals just how major childhood trauma can affect one in later life. Complex trauma can be overwhelming, not just for an individual but for their families and even their community.

Inter-generational trauma is often seen and when entrenched can undermine the wellbeing,

life experiences and history… open and genuine collaboration between provider and consumer at all phases of the service-delivery; an emphasis on skill building and acquisition rather than symptom management; an understanding of symptoms as attempts to cope; a view of trauma as a defining and organizing experience that forms the core of anindividual’s identity rather than a single discrete event, and by a focus on what has happened to the person rather than what is wrong with the person… Without such a shift in the culture of an organizaSummer 2016 healthspeak

CASE STUDY The patient

A middle-aged man on a pension living on the North Coast in public housing with a mental health issue.

Previous services

He first visited NSW Oral Health in 2002 for emergency treatment with 16 visits between 2002 and 2011. Each visit was brief with one problem fixed at a time.

April 2011

At this time the patient was screened for the student facility at Ballina and diagnosed with an overwhelming amount of dental disease and very poor oral hygiene. Three teeth were beyond rescue and 20 restorations were necessary.

At the student clinic he was educated on diet, oral hygiene and smoking cessation. He

at all clinics while also providing acute care.

Dr Kreutzfeldt recently presented a case study of a typical patient attending Northern NSW LHD Oral Health to demonstrate the change in approach and services offered before and after the student clinic in Ballina commenced in 2011.

underwent debridement and fluoride treatment. The patient also underwent some intense months with 18 visits but his oral health was restored and some of his habits improved.

One-year review

The patient had an additional three restorations, root canal treatment, habit change education and debridement.

Two-year review

Two small repairs, debridement and education, although still smoking.

Latest visit

Patient’s oral health has changed dramatically and he is now able to maintain his teeth for life which will affect his life and health positively. No need for dentures, just a follow up appointment annually.

Patient’s response

The patient was ‘over the moon’ with the degree of atten-

spirit and social cohesion of a whole community. This problem is over-represented in Indigenous communities.

The Federal Government’s move to reduce household violence addresses not only the acute trauma but may result in longer-term public health benefits. The potential flow-on benefits are a reduced chronic disease, including a range of mental health and drug and alcohol problems.

GPs are ideally placed to be at the frontline of listening and understanding the implications

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tion he received at the clinic, he noticed a big change in patient care. Everything ran smoothly with thorough assessment of his needs and supportive clinicians.

He said he ‘could only imagine’ the state of his teeth if he’d not had the treatment.

The patient said he found the students very professional and pleasant and was impressed with the team approach. He said that while he didn’t enjoy his visits prior to 2011, since attending the student clinic all his expectations had been met and he enjoyed attending and appreciated the yearly follow up appointments to maintain good oral health.

GPs can recommend eligible patients to register by calling the Oral Health Customer Service Line on 1300 651 625.

of the stories of ACE sufferers, regardless of their age. It is not a matter of ‘just get over it’ or hoping that medications can solve the problem.

Link: Women’s Safety Package details www.malcolmturnbull.com. au/media/release-womens-safetypackage-to-stoptheviolence Further reading: www. recoveryonpurpose.com/upload/ ASCA_Practice%20Guidelines%20 for%20the%20Treatment%20 of%20Complex%20Trauma.pdf

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Pets help keep residents healthy and happy

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oving into residential aged care can be stressful, particularly when people are faced with having to give up their cherished four-legged loved ones. This all-too-common dilemma is faced by many people because many aged care facilities don’t allow animals.

A key point of difference for Feros Care’s three aged care facilities in Byron Bay, Bangalow and Kingscliff is that they welcome all kinds of animals to move in with their owners. This eliminates the heartbreak for residents having to leave a pet, and helps them to settle more easily into their new home.

Pets provide companionship, unconditional love, encourage exercise, and their spontaneity can help new residents settle in and well as engaging with visits children and families.

Pets play a vital role in residential care, and bring normal-

which leads to fewer visits to the doctor.

Residents tend to be more active and playful with pets around, making them feel more energized. This increase in physical activity also improves

balance, mobility and stronger bones.

The positive effect pets have on residents in residential aged care is invaluable in easing a person’s loneliness and providing a sense of security.

Helping a patient with a gambling problem Feros resident Noel enjoying time with his cat.

ity to the day for many people.

Research shows that stroking a pet can decrease a person’s level of stress and help alleviate stress-related disorders and depression.

Having dogs, cats, birds and fish around can reduce blood pressure, and encourage people to take better care of themselves

Come and hear experts discuss the future direction of allied health and health care Integration. NCAHA is establishing itself as a benchmark for regionally focussed allied health representation and networking.

For more information and registration, go to: www.amsn.com.au/events

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ental Health First Aid Australia has prepared some resources to help health professionals proceed with an intervention to help a patient with gambling problems.

The guidelines were prepared following research and expert professional consensus on the issue.

They cover the following topics • How to tell if someone has gambling problems

• How to talk to someone about their gambling • Encouraging professional help • Encouraging the person to change • What to do if the person does not want to change The guidelines are free and can be downloaded at: mhfa.com.au/resources/ mental-health-frist-aidguidelines

Let’s Get Connected Allied Health Seminar OPAL COVE, COFFS HARBOUR, 5-6 MARCH 2016 Keynote speaker: Prof Kathryn Refshauge

For more about NCAHA go to: www.ncaha.org.au North Coast Primary Health Network Gold Sponsor MNCLHD Silver Sponsor

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a publication of North Coast Primary Health Network

healthspeak Summer 2016

Specialist wound care at Tweed Super Clinic

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egistered nurse and wound management consultant Gerard Robards is one of the most experienced and highly qualified wound care practitioners in Australia.

Gerard graduated from Griffith University in 1994 with a Bachelor of Nursing and after spending four years in Saudi Arabia working in quality management returned to the Gold Coast to continue his passion wound management.

He completed a Master of Wound Care by research from Monash University in 2012, where he was awarded the Golden Key international Honour Society Certificate for outstanding academic achievement and the ConvaTec Master of Wound Care Prize for his research into patients with chronic wounds.

Specifically, Gerard examined the diagnostic validity of using clinical signs and symptoms to identify localised infection in patients with chronic wounds.

Gerard is also active in research and education, taking Southern Cross University podiatry students on lengthy work pracs for up to five months of the year.

When HealthSpeak visited Gerard at his place of work – the Tweed Health For Everyone Super Clinic – he was moving between patients at the bustling wound care clinic, giving each of them the individual attention he is well known for.

Gerard loves his work and strives to find the best solutions for everyone he sees. His personal oversight of each patient’s wounds relieves minds and ensures excellent results.

“There’s a lot of satisfaction in wounds that have been difficult to heal and helping people to better manage their pain.

“I enjoy working in a team environment. At the Tweed Health for Everyone Super Clinic we have a great team of dedication GPs, allied health professionals, nurses and reception staff who Summer 2016 healthspeak

From left: Janine and Bob Price with Wound Management Consultant Gerard Robards.

There is more to wound care than just treating the wound itself. use the latest evidence-based practice to deliver quality outcomes for our patients.

“There is more to wound care than just treating the wound itself. For example, nutrition, blood flow, and general wellbeing may all directly affect the healing of wounds. Wound management is multi-dimensional and each case is different. When patients see improvements in their wound as a result of the treatment we prescribe, it is very satisfying,” he said.

Gerard treats a wide range of wounds including, but not limited to, trauma injuries, burns and pressure injuries. The most common are venous, arterial and mixed arterial ulcerations.

Wounds associated with diabetes also commonly present at the clinic. Often, Gerard is confronted with wounds affected by the impacts of diabetes, or he deals with the end result of amputations. Gerard also works closely with the upper Clinic’s Skin Cancer team treating patients

post-surgery.

“I work closely with the skin cancer surgeons here at the Super Clinic and assist with the pre-operative work and postoperative management. At the pre-op stage, I am involved in patient screening and education.

Post-surgery, my attention shifts to the ongoing management and treatment of the wound using compression therapy, advanced wound management therapy and products.

In the past, patients requiring a lower leg excision and graft would have had to enter hospital for this procedure and remained in the system for post-operative treatment. However, that’s no longer necessary – we can successfully treat grafts on an outpatient basis,” Gerard explained.

Gerard paid tribute to the clinic’s skin cancer physicians Dr Chris Weatherall and Dr Greg Cusick whom he said had really taken the skin grafting potential of the clinic to another level.

On the day HealthSpeak visited, Gerard was attending to a deep hole in the heel of a patient (Bob) who lives in a residential aged care facility.

The hole was the result of a pressure injury. Apparently such ulcerations are not uncommon in frail aged people who have restricted mobility. Gerard also

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commented on the benefits of combining negative pressure wound therapy with the clinic’s state of the art ultrasonic wound debridement system which is achieving some outstanding results.

Before coming to the clinic, many patients are upset and dispirited because their wounds are not improving. Gerard and the team seek to change that by applying their knowledge and experience.

Recently, a patient who had suffered for two and a half years with a lower leg ulceration was holidaying on the Tweed Coast and heard about Gerard’s results and the wound care clinic. That patient now travels from Inverell once a week (a 15-hour round trip) for the specialist treatment that Gerard and his team can provide.

“We’ve almost healed her wound after five weeks of treatment and we are all very happy with the results. And we’ve tapped into a community health service at Inverell where staff can treat the patient’s wound with compression therapy between her visits to us. This has allowed us to ensure continuity of care and been convenient for the patient. It has been great to see her wound heal so quickly.”

Continued page 34

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Koori Grapevine Bugalwena CKD program wins award

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project targeting Indigenous patients with chronic kidney disease at Bugalwena General Practice in South Tweed Heads has been recognised with a NSW Health Award. Bugalwena General Practice is managed

by North Coast Primary Health Networ (NCPHN).

The aim of the project was to improve identification and management of Indigenous clients with early stages of chronic kidney disease.

NSW Health Awards recognise the excellence of nurses, clinicians, allied health professionals, support staff, researchers and volunteers, who strived on a daily basis to develop and implement innovative models of care with the aim of improving outcomes for patients across NSW. Announcing the Bugalwena award, NSW Health Minister Jillian Skinner outlined the success of the program which involved Northern NSW Local Health District renal nurse practitioner Graeme Turner and Bugalwena practice staff.

“Before the project began at

Jackie Moody

the Tweed Heads Bugalwena General Practice, only two per cent of adult clients were identified as having the disease. That has now grown to 10.7 per cent,” Mrs Skinner said.

The idea for the project came from Bugalwena Practice Manager Jackie Moody and NCPHN Practice Assistance Liaison Officer Kelli Babovic.

Both Jackie and Kelli wished to improve the care of patients with Chronic Kidney Disease (CKD) and through their efforts Bugalwena set a goal to increase the identification of patients with potential CKD so that specific health management plans and team care arrangements could be

Kelli Babovic

put in place.

A workshop was organised for the Bugalwena team and renal nurse practitioner Graeme Turner gave a presentation on how to improve the practice’s management of CKD. To achieve their objective, the Bugalwena team then took the following steps: • Focused on cleaning up their CKD register data and updated processes • Jackie used the PENCAT tool to create a list of patients at risk of CKD • Software was tweaked so that when a patient at risk of CKD saw their GP, the GP

was reminded to code CKD correctly • A urinary albumin creatinine ratio check was implemented as part of health checks which increased the patients on the CKD register • Jackie sent lists of Bugalwena patients at risk of CKD to pathology companies to see if they had had relevant kidney function tests at other practices. Results were then downloaded, resulting in increased CKD patient numbers.

The project increased the number of Bugalwena patients on the CKD register there from 17 patients in April 2014 to 77 in August 2014. Management plans and team care arrangements were implemented for the vast majority of patients.

The Bugalwena project was undertaken as part of the Australian Primary Care Collaboratives improvement program funded by the Department of Health and delivered by the Improvement Foundation.

Acute kidney hospitalisations on the rise

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ospitalisation rates for acute kidney injury have more than doubled over the past decade, and this condition affects some population groups more than others, according to a report released by the Australian Institute of Health and Welfare (AIHW).

The report, Acute Kidney Injury in Australia: a first national snapshot, is the first Australian national report on acute kidney injury. Sadly, hospitalisation and death rates were at least

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twice as high among Indigenous Australians as other Australians.

Acute kidney injury occurs when there is an abrupt loss of kidney function. It is often the result of injury or trauma, or extreme inflammation. Risk factors include advanced age, diabetes, hypertension, obesity, cardiovascular disease and preexisting chronic kidney disease.

The condition may progress to severe kidney damage and result in end-stage kidney disease

and long-term dialysis or death.

The report shows that there were 131,780 hospitalisations involving acute kidney injury in 2012-13 representing 1.6% of all hospitalisations. In the 85 and over age group hospitalisation rates were at least four times those of the 65 to 74 age group.

‘When looking just at hospitalisations for acute kidney injury we see a substantial increase in hospitalisations, with the annual number more than

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doubling from 8,050 to 18,010 between 2000/01 and 2012/13,’ said AIHW spokeswoman Sushma Mathur.

The average length of stay in hospital for acute kidney injury was twice as long as it was for hospitalisations overall (11.4 days compared with 5.6 days).

Acute kidney injury is an under-recognised condition in Australia.

healthspeak Summer 2016

Improvements in Indigenous primary care

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report from the Australian Institute of Health and Welfare (AIHW) shows improvements against a range of national key performance indicators for primary health care organisations providing care to Aboriginal and Torres Strait Islander Australians.

The report, National key performance indicators for Aboriginal and Torres Strait Islander primary health care: results from December 2014, is the 3rd in a series of reports, and presents information from 233 organisations.

The report provides information focussed on maternal and child health, preventative health and chronic disease management. Data have been collected over 6 reporting periods between June 2012 and December 2014.

Nineteen of the 27 measures look at primary healthcare organisations’ processes-of-care, which assess whether clients have received relevant tests or had their risk factor status recorded. These are largely under the control of organisations, so

can be used to assess the organisations’ performance.

‘Our report shows improvements in 17 out of the 19 process-of-care measures across all organisations,’ said AIHW spokeswoman Dr Fadwa AlYaman.

In December 2014, birthweight had been recorded for 69% of babies, information had been recorded on smoking status for 78% of clients, alcohol consumption for 55% and adult health checks for 44%. Among clients with type 2 diabetes, 50% received Medicare Benefits Schedule (MBS) GP management plan and 47% an MBS team care arrangement.

Better results were recorded for a number of health outcome measures: of the clients with type 2 diabetes, 35% had a good HbA1c (haemoglobin A1c-an indicator of long-term diabetes control) result in the previous six months, 44% had a blood pressure result in the normal range, and 81% had good kidney function result.

Guidelines for taking on Indigenous staff

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mployers looking to hire Aboriginal and Torres Strait Islander people have a new resource from the Australian Human Rights Commission (AHRC).

‘Targeted recruitment of Aboriginal and Torres Strait Islander people – A guideline for employers’ was launched last month by the Aboriginal and Torres Strait Islander Social Justice Commissioner, Mick Gooda; the BCA chief executive Jennifer Westacott; and Stephen Woodbury, Ashurst partner.

“Despite efforts to close the gap in Indigenous disadvantage, the disparity between employment of Aboriginal and Torres Strait Islander people and non-Indigenous Australians has increased in recent years,” said Commissioner Gooda.

“Fewer than half of workingage Aboriginal and Torres Strait Islander people are employed, compared to over three quarters of non-Indigenous Australians.

“Increasingly, employers are Summer 2016 healthspeak

seeking to create employment opportunities for Aboriginal and Torres Strait Islander people through targeted recruitment strategies,” Commissioner Gooda said.

Commissioner Gooda said targeted recruitment strategies include measures such as reserving positions for Aboriginal and Torres Strait Islander applicants and guaranteed interview schemes. Other strategies include work placements or mentoring programs; and engaging an Indigenous recruitment service to hire employees.

“These guidelines will assist employers by giving them the certainty they need to develop targeted recruitment strategies without concern about breaching discrimination laws,” BCA chief executive Jennifer Westacott said.

“This means employers are better positioned to help close the employment gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians,” she added.

View the publication here: www.humanrights.gov.au/ our-work/aboriginal-and-

torres-strait-islander-socialjustice/publications/targetedrecruitment

Indigenous Assistant Health Minister

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he Federal Ministerial reshuffle that followed Malcolm Turnbull’s ascendancy to Prime Minister, resulted in the first Indigenous Minister in Australia to take on a health portfolio.

Ken Wyatt, the first Indigenous member of the House of Representatives and the Federal Member for Hasluck in Western Australia, has been appointed Assistant Minister for Health.

Sussan Ley retained her role as Health Minister, while Fiona Nash is now the Minister for Rural Health, and Nigel Scullion continues

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in the Indigenous Affairs portfolio.

Mr Wyatt has considerable experience in the health sector, including District Director for the Swan Education District and Director of Aboriginal Health in Western Australia.

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Arts Health & Wellbeing Puppets give purpose to Peta

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eta Jane Lipski’s house is crammed full of puppets she’s made and recyclable materials she might be able to use to create them. She works on her puppets day and night, often staying up to the wee hours to finish one of her creations.

Peta, an artist and performer who lives on her own at Byron Bay, was born in Sydney with a cleft palate and deaf in one ear.

Her speaking voice is difficult to understand and Peta had a difficult childhood at school where she was isolated. At home, too, it seems her family didn’t really know how to help her.

Peta is currently involved in an integrated dance and creative workshop at Sue Whiteman’s Alstonville Dance Studio for people with a disability and anyone else who wishes to join in, and HealthSpeak caught up with her there.

She spoke about the death of her father when she was a child, who drowned while fishing off some rocks. Clearly this event had a dramatic effect on Peta who still draws pictures of her father in the sea.

The move to Byron Bay as an adult where she has her own home was an important turning point for Peta. She relished the idea of not living with her family, although her mother now lives nearby. She said these days she is able to do what she wants with her life, although it has its difficulties.

Peta has become somewhat of an identity on the Northern Rivers. Despite her speech difficulty, she loves to talk and has opinions on a wide variety of topics.

On arrival at the dance studio mid afternoon, Peta is wearing a striking royal blue military top with gold trim. She shows me some of her favourite puppets including a metre tall man puppet 22

Peta with filmmaker Andy Mambach

Peta showing us one of her puppet creations

Looking at toys gives me ideas to make artworks and puppets she’s been working on. She says she gets a lot of inspiration from toys.

“Looking at toys gives me ideas to make artworks and puppets.

Making this two-headed horse, I had to buy most of the horse but I added another head, which makes it more interesting.”

Peta uses cardboard, and objects such as empty shampoo bottles, pipe cleaners, plastic, fabric and garments to produce her puppets. She’s also making basic marionettes.

“I’ve worked out how to add strings to make parts of the puppet move. took him (the man puppet) up to Housie at the Bowling Club last night and people were saying how wonderful that I made it. Some ladies don’t like the sticking out teeth.

But I’m happy with what I’ve made, I like the hair sticking out, why not? He’ll have a puppet lady soon in a couple of weeks,” Peta said.

Sue Whiteman is hoping she can use Peta’s puppets and Peta’s skills in her school holiday creative workshop. She is mentoring Peta, whom Sue believes has the potential to be a teacher. Peta has also recently been the star of a three-minute film made by Byron Bay filmmaker Andy Mambach.

The film, funded by Creatability, follows Peta as she makes

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her way around some op shops in Ballina gathering materials for her puppet making. Andy said he had some ‘exciting moments’ during the making of the film.

“During that day Peta found a horse that she could ride, a wooden toy horse and proceeded to take this horse with her wherever she went for the rest of the day which was quite fun, and it turned a lot of heads,” he said with a big smile.

Andy was also amazed at Peta’s prolific creative output.

“She’s been documenting and drawing stories of her life in many photograph albums. She’s producing hand drawn pictures of life moments with captions on the side. It was amazing to have her tell me the story while she’s showing me these beautiful pictures.”

The Creatability film stories will be available on ABC Open online and it’s hoped they will also be broadcast on ABC TV. When HealthSpeak leaves the dance studio, Peta is captivating the children and their carers with an impromptu talk on puppets and helping to put on a puppet performance.

“My dream is to find a way to make money out of my puppets and my artwork. Someday I’d love to be touring the country putting on puppet performances.”

healthspeak Summer 2016

The Art of Calming

By Andrew Binns

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tress and anxiety seem to be part of most people’s lives today. There is always something to worry about, partly fed by the 24-hour news cycle of alarming issues and the frenetic pace of life. Social media anxiety is also common, particularly among the younger generation. A hundred years ago people no doubt had other matters to concern them such as world wars and infectious disease epidemics, but this does not lesson the encompassing pressures of the digital age.

Post-traumatic stress disorder from adverse childhood experience or other major trauma in later life is also common in our society and a condition we are becoming increasingly aware of in primary care. The mental and physical health implications of this in later life are a major challenge for those that suffer as well as those who care for them.

Medications and psychological therapies can be of benefit but they do not wipe out all the painful memories, flashbacks and the suppressed and dissociated thoughts loitering in the brain. Some sufferers look to drugs, tobacco and alcohol as an easy and immediate way of selfmedicating, but the excessive amounts needed to quell anxiety can be extremely harmful.

So are there other ways to calm the mind? Creative arts activities are well recognised for their therapeutic benefit.

This may include music, dance, visual art, craft, theatre, writing and all forms of storytelling.

In the case of Art Magic: Remnant an exhibition recently held at the Lismore Regional Gallery, artist Hiromi Tango’s workshops involved so many of these cross art forms and she has the ability to engage people from all walks of life for activities that are calming, uplifting and a lot of fun.

Hiromi is a highly regarded sculptural installation and Summer 2016 healthspeak

Photo by Natsky

Tango does not consider herself an art therapist but there is no doubt her art is therapy for those who participate performance artist who uses textiles to weave together tactile and immersive environments by hand. Her stunningly intricate works use new and recycled fabrics, yarn and objects. She worked with local community members to make a Rainbow Forest, responding to the flora, fauna and landscape of the Lismore region.

Art therapy is based on the idea that the creative process of art making is healing and life enhancing – a form of non-verbal communication. Tango does not consider herself a professional art therapist but there is no doubt her art is therapy for those who participate as well as

for those who view and appreciate her work.

Creating works of art or craft is an effective activity for working with both adults and children coping with many conditions affecting brain function, including trauma. The experience may act as a form of subconscious expression where hidden inner conflicts and emotions are aired. The process can engender self-esteem, selfawareness and lift the spirit.

There has always been a fascination amongst neuroscientists about the anatomy of the brain and function and in recent years this knowledge has advanced with technological advances in magnetic resonance neuroimaging (MRIs) which allows for observing which part of the brain responds to specific stimuli. Also the brain is now thought to be not made up of fixed circuitry like a computer but demonstrates neuroplasticity. That means it has the ability to change and adapt in response to different stimuli and experience.

When a traumatic event is

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recalled, neuroimaging can demonstrate dis-association (which can manifest as amnesia, depersonalisation and emotional detachment). The left prefrontal cortex, specifically Broca’s area (responsible for speech) remains relatively inactive whilst the right hemisphere particularly the region around the amygdala (associated with emotion and arousal from fear) is particularly active.

This fear, overpowering our ability to verbally communicate, can be reversed by relaxing and meditative activities which can regulate and calm down the stress response. Tango’s workshops engage the five senses in a way that has the potential to stimulate the areas of the brain relating to pleasure whilst shutting down the neurophysiological connections relating to fear.

What really matters is the benefit gained from these activities. Testimonials speak for themselves and the feedback from Tango’s workshops was impressive.

Such is the magic of Hiromi Tango’s art.

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UCRH renal research honoured

Liz Rix with the painting ‘The journey of Aboriginal people in regional & rural NSW on Haemodialysis’ by the late Patsy Nagus who assisted with her doctoral research.

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CRH researcher Liz Rix was invited to present at the October conference of the American Indigenous Research Association in Montana, USA to present her PhD research on Aboriginal people’s experiences with renal care.

While Liz is not an Indige-

nous person, the extensive work behind her thesis was focused on Aboriginal communities in the NSW Northern Rivers.

She believes that the experiences and views of the renal patients in her research group would be common to many across Australia. She paid tribute to a number of local Aboriginal people who helped her gain the confidence and cooperation of renal patients.

They include Patsy Nagus, who has since passed away, Russell Kapeen, and Charles Moran.

Liz’s research also drew on the experiences of health professionals involved in the care of indigenous patients with renal disease, which Aboriginal people experience at a rate eight times higher than non-Aboriginal.

“No previous studies in rural Australia have explored the experience of Aboriginal patients with haemodialysis or renal services delivery, nor of those providing their care,” Liz said.

“Among the findings was that

‘Family’ is a key motivator for persevering with haemodialysis, a demanding process that lasts up to six hours and must usually be undertaken three times a week if done in-centre.”

Crucially, ‘institutional’, rather than individual racism was found to be a barrier to effective care for Aboriginal renal patients.

“I found minimal racism at the individual level, with both participant groups demonstrating the motivation and goodwill for improved relationships and better understanding between them,” said Liz. UCRH Director Professor Lesley Barclay said, “Liz Rix’s

research is a significant contribution to the body of knowledge about one of the major diseases affecting Aboriginal people, not just on the North Coast but Australia-wide.

DIY Events Promote your health event through NCPHN We have set up a ‘do it yourself’ system so that organisers can post events on our Healthy North Coast website. healthynorthcoast.org.au/ dashboard/signup/ Once you register, you can post event information quickly and easily.

‘Your Health Link’ fb page

After hours GP in Pottsville

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entral Pottsville Medical Centre (CPMC) is opening extended hours in the New Year to cater for patients who can’t come during normal business hours.

Practice Manager Annalea Patch said the medical centre would be opening Monday to Friday from 8.30am to 9 pm and on Saturdays between 9am and 2pm.

It is currently open from 8.30am to 6.30 Monday to Friday.

“Our practice wanted to better serve the community and so we decided to provide consultations outside of normal working hours. Not everyone can make it to the medical centre during work hours,” said Annalea.

CPMC also has four full-time GPs on staff, and one part-time doctor. The practice also has a psychologist, a physiotherapist, a speech pathologist and cardi24

Your Health Link Program Officer Paul Miller with the Facebook page that aims to help people of all ages access health information quickly.

T GPs Dr Sandye Walpola and Dr Gayani Jayasinghe work full-time at Central Pottsville Medical Centre.

ologist who visit the centre on a regular basis.

In August, Central Pottsville Medical Centre successfully completed its RACGP accreditation, just 12 months after opening its doors.

he Mid North Coast Local Health District’s health information website, Your Health Link, has expanded its reach into social media.

As a public website, Your Health Link is helping people of all ages to access health information quickly and improving their understanding of health-related issues. The initiative has links to more than 500 government and non-government organisa-

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tions chosen by health professionals. And now there’s a Facebook page.

The health and wellbeing page features regular posts about topical issues, such as Mental Health Month, men’s health and even healthy food recipes from the Heart Foundation.

Your Health Link can be accessed at www.yourhealthlink.com.au or on Facebook by searching Your Health Link. healthspeak Summer 2016

Feature

Improving care for acute low back pain on behalf of the ACI musculoskeletal network acute low back pain Working Group

By Dr Chris Needs Rheumatologist, Port Macquarie

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usculoskeletal conditions affect hundreds of millions of people worldwide. In people over 60, joint diseases account for more than half of their chronic conditions.

Low back pain is recognised as a major cause of disability with a quarter of Australians experiencing it at any one time. High levels of disability result in personal and societal costs. It is the most common health condition that results in a person retiring from work early and a report from Deloitte identified health costs for the management of ‘back problems’ in Australia in 2012 to be almost $A4.8 billion.

To address the increasing burden of musculoskeletal disease, the Agency for Clinical Innovation (ACI) has sponsored the development of a Model of Care for the Management of People with Acute Low Back Pain. Its key objective is to reduce pain,

Summer 2016 healthspeak

promote function and reduce long-term disability through evidence-based assessment and treatments coupled to a patient flow pathway.

ACI had previously developed Models of Care for osteoarthritis, and osteoporotic re-fracture prevention which are also part of the musculoskeletal Initiative between selected primary health networks and LHDs across NSW. Acute low back pain (ALBP) is defined as a new episode of low back pain (expressed as pain between the 12th rib and buttock crease), with or without leg pain, that has a duration of less than three months and was preceded by one month of no pain. The model acknowledges there are people who experience acute exacerbations of back pain over many years, and providing they have experienced one month free of pain prior to the new episode, they are included in this Model. Chronic low back pain is that lasting longer than three months. A key problem in managing low back pain is the

number of people who develop chronic low back pain following an ALBP episode. It’s expected that early appropriate care may reduce such a transition.

Studies have shown that about 40% of those reporting an episode of ALBP will have recovered within six weeks. However, 48% will still have pain and disability after three months and of these almost 30% remain unrecovered at 12 months.

Current data reveals international assessment and treatment guideline recommendations are not being adhered to. This is evidenced by the liberal use of spinal imaging, overuse of opiate analgesia, and recommendations of bed rest. Spinal imaging is recommended only for people suspected of having serious pathology and those with persistent low back pain with signs of neurological compromise.

Approximately $220 million was reimbursed by Medicare in 2013 for spinal imaging, much of which could have been avoided if guidelines for ALBP were followed. Public hospital waiting

lists for spinal surgical opinions are increasing, yet in hospitals where evidenced based guidelines have been implemented the wait list has been reduced.

The ACI Model of Care was developed in consultation with the ACI Pain Management Network that is leading improved care processes for people with chronic pain across NSW. This collaboration ensures the interventions and messaging are congruent across acute and chronic pain management.

In addition to GPs, network members contributing to the Model included neurosurgical and orthopaedic specialties with contributions from physiotherapists, occupational therapists, nurses, consumers, rehabilitation specialists and rheumatologists.

It is agreed that people with ALBP should ideally be managed in primary care where follow-up over time can be provided and self-management supported in a wellness model.

Continued pages 26-28

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The ACI Model

Feature Improving care for acute low back pain

The ACI Model of Care for the Management of People with ALBP has been developed for people aged 16 and over who present to their GP or emergency department with a new episode of ALBP (low back pain of less than three months duration, with or without leg pain, and preceded by one month of no pain).

ALBP commonly occurs without associated pain radiating down the legs. Leg pain in association with acute low back pain may be the result of injury of lumbar nerve roots or somatically referred pain into the leg without nerve root injury.

The model of care provides different care pathways for patients using three triage classifications: (i) non-specific low back pain, (pain between the 12th rib and gluteal crease) (ii) low back pain with leg pain and (iii) suspected serious pathology (red flags).

While multiple practitioners could be involved, the primary team members comprise the patient and family, their GP, practice nurse and physiotherapist.

The expectation is that where a range of health professionals is not accessible, there may be a need to train those available to deliver the therapies traditionally provided by another health professional. For example, cognitive behavioural principles (CBT) of pain management have not been a traditional element of physiotherapy undergraduate education. Therefore, it may be necessary to train physiotherapists or other health professionals not previously exposed to CBT principles to deliver psychologically informed interventions.

Most people with ALBP improve within six weeks when treated according to evidencebased guidelines. The factors that predict a poor outcome (yellow flag issues) and the development of persistent LBP are complex and include a range of biophysical (pain intensity, presence of leg pain) psychological (co-existent psychological distress) and social issues (job dissatisfaction, compensation).

Cultural perceptions about LBP may result in a belief that any episode of ALBP is a career-ending event. Likewise, harbouring unrealistic expectations of medical therapies often results in patients thinking it is only a matter of finding the correct treatment and their pain will resolve. Such beliefs may also impact upon the health professional’s approach to patients. As such, the chronic care principles of a patient-centred approach to identify potential poor prognostic factors are required in order to address these using psychological, physical and pharmacological approaches.

Key treatment principles

1. Assessment: history and examination 2. Patient education 3. Risk stratification regarding yellow flag barriers to recovery 4. Active physical therapy

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encouraged 5. Only image those with suspected serious pathology 6. Begin treatment with simple analgesics 7. Cognitive Behavioural Therapy approach 8. Judicious use of complex medicines (tricyclic agents and anti-epileptic medication) 9. Pre-determined times for review 10. Timely referral and access to specialist services

Cultural perceptions may have patients believing ALBP is a career ending event The initial patient encounter will use a pathways approach through triaging patients according to whether the ALBP is associated with leg pain, plus or minus neurological signs or is accompanied by clinical features suggesting serious spinal pathology. The presence of symptoms and signs to suggest serious spinal pathology are documented and then acted upon at this first visit.

The treatment modalities comprise physical therapies, psychologically informed physiotherapy, psychological therapies, along with pharmacological therapies.

Assessment: history and examination

The initial assessment is based upon a complete history, physical examination; and where indicated a focussed neurological examination so as to triage patients into those with LBP alone (non-specific back pain) or those who have back and leg pain. At this time people exhibiting signs of spinal infection; or with bladder or bowel dysfunc-

a publication of North Coast Primary Health Network

tion (signs of cauda equina compression) require immediate referral to an emergency department. However, relevant investigations will be undertaken when the patient has a history of previous malignancy, or symptoms and signs of inflammatory arthritis, or a history of trauma. Such investigations may be undertaken in patients with back pain who also have osteoporosis; vertebral fracture may arise with minimal trauma. (red flags).

Following assessment and referral of people with red flags, most people will be found to have non-specific LBP. No imaging is required. The other possible cohort arising from the first visit will comprise people with LBP and leg pain with or without neurological signs. The smallest group would comprise people with signs and symptoms of progressive lower limb neurological loss.

Patient education

At the first consultation, education is vital and should be provided to all patients. This may include a DVD to watch or a web site to visit such as: http://www.youtube.com/ watch?v=BOjTegn9RuY or http://painhealth.csse.uwa.edu. au/pain-management.html The patient must then be able to discuss the contents of the information and their response to the material with a team member before leaving. Information packs should be given out to verify self-management strategies to be implemented between consultations.

There is indirect evidence that evidence-based, personfocussed health education alone may reduce the length of time that ALBP persists. Guidelines recommend that patients should be advised to remain active, avoid bed rest, and be reassured of the favourable prognosis of ALBP. It is arguable that this is the most important aspect of care that health professionals can provide.

healthspeak Summer 2016

Fears about future health, employment prospects or remaining independent at home may be triggered by an episode of ALBP. The identification of such beliefs as well as maladaptive illness behaviour, catastrophic thinking and depressed affect (yellow flags) are critical in improving outcomes and preventing progress to chronic pain. Assessment tools such as StarTBacK or Orebro help in identifying these risks for poor outcomes but the same information may be gained by direct questioning.

The purpose of splitting the non-specific ALBP cohort into those with significant yellow flag issues and those without is that therapies directed at addressing fear and catastrophic thinking will impact favourably on the outcomes of an episode of ALBP. Failure to incorporate such approaches into treatment protocols will produce poor treatment outcomes.

Physical Therapies

Passive physical therapies such as ultrasound, interferential therapy and massage, have a limited role in ALBP. The US guideline recommends only superficial heat as a self-care option and spinal manipulative therapy delivered by a physiotherapist or chiropractor.

Acupuncture, electrotherapy modalities, massage, traction and lumbar supports should be avoided as evidence suggests these offer no benefit.

The contemporary approach is very much a move away from the patient being a passive recipient, to one where the clinical team member will teach the

Summer 2016 healthspeak

Evidence reveals improved outcomes for people with ALBP when CBT is used to inform the delivery of physical and other therapy activities should be the physical therapy focus without a separate structured exercise program.

In fact, there is some evidence that exercise can delay recovery when commenced in the early acute phase. Once the patient has recovered from the acute episode there is value in considering an exercise program as trials have shown that exercise programs begun at this point can halve the risk of recurrence.

Spinal imaging

Reviews universally conclude that radiological imaging for ALBP without red flags or signs of neurological loss is not appropriate. While such imaging requests may be initiated

by GPs, increasingly physiotherapists, osteopaths and even podiatrists are urging patients to request imaging from their GP. This situation contributes to poor guideline compliance in primary care.

Analgesia

outcomes for people with ALBP when CBT is used to inform the delivery of physical and other therapy, helping to modify any psychosocial drivers for pain. The clinician and the patient analyse the relationship between beliefs and pain behaviours together, then develop a goal-orientated plan used to monitor progress over time. Such approaches help the person self-manage their pain control during future episodes.

However, when yellow flags are identified or pain persists past the 14- week review, a more complex psychological intervention may be needed. Such treatments should be invoked earlier if needed.

Regular paracetamol is recommended for ALBP. However, both clinician and patients should be mindful that a recent trial demonstrated it was no more effective than a placebo plus “best evidence education�.

If during the course of treatment patients become aware that paracetamol is not helping, then cessation and review for additional analgesia, such as NSAIDs, is suggested. NonSteroidal Anti-Inflammatory Drugs (NSAIDs) are recommended for reducing pain for short periods. However, before prescribing NSAIDs, assessment for contraindications is required. These include severe hypertension, renal disease, previous gastrointestinal haemorrhage and corticosteroid use.

The lower incidence of gastrointestinal side effects needs to be balanced with increased cardiovascular risks associated with some of the COX-2 NSAIDs. The judicious short-term use of low dose opiates may also be required; however in general, opiates are best avoided.

Complex pharma therapies

Patients with radicular pain (pain that radiates into either or both legs, often accompanied by numbness) may benefit from tricyclic antidepressants, anticonvulsant agents and serotonin noradrenaline reuptake inhibitors. Some anticonvulsant medications may have a clinically relevant effect in the treatment of neuropathic

Cognitive-behavioural approaches

These approaches, not necessarily management by a clinical psychologist, are to be used within the ALBP model of care and include simple CBT even for those without yellow flags.

An introduction to these approaches is provided in the special issue of physical therapy on psychologically

Continued next page

informed practice.

Evidence reveals improved

a publication of North Coast Primary Health Network

27

Feature

Stratification of care

person about the condition, suggesting the importance of strategies for self-management and guiding the staged resumption of normal activities. Many techniques used in managing chronic pain such as pacing and goal setting can be applied to the ALBP scenario and are clearly outlined in the ACI Pain Management Network model of care: http://www.aci.health. nsw.gov.au/chronic-pain/foreveryone/pain-and-physicalactivity During the initial stage of recovery, guiding the person to resume normal physical

Improving care for acute low back pain

Health practitioners who know their patients well are aware of the impact certain descriptors may have on the patient’s understanding of their condition. Awareness of the language used will have a lasting impact upon the patient with a first episode of ALBP.

Story Dogs provide unconditional support

F

or several years, NCPHN staff member Karla Albert has volunteered at Ocean Shores Primary School, accompanied by Lucy, a very special canine.

Karla takes part in a special program, Story Dogs, that is free of charge, staffed by volunteers and makes a difference to the lives of many children.

“The beauty of Story Dogs is that the kids read to the dogs, who don’t judge and don’t care how well they read! Story Dogs makes reading fun for these children, some of whom have never read before and the program has had really amazing results.

“I have been volunteering in literacy support programs for nearly 10 years and found Story Dogs one of the most effective ways to help children learn to From page 27

pain; however their efficacy in the treatment of all causes of leg pain associated with LBP is unclear. The clinician must carefully consider the impact of potential mood changes and somnolence when using these agents. Generally opiates are less effective than other agents for neuropathic pain.

Spinal corticosteroid injections are increasingly used to treat radicular pain and lumbar spinal canal stenosis. The available evidence suggests that epidural corticosteroid injections (whether given via a transforaminal or inter-laminar route) offer only short-term relief of acute radicular pain and minimal or no benefit for lumbar canal stenosis. Spinal injections in the primary care setting are not recommended.

Little evidence exists to support facet joint/trigger point injections or prolotherapy and their use in primary care is also discouraged.

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Lucy, a beautiful Labrador cross who has been part of Karla’s family for five years

read,” Karla told HealthSpeak.

She said that often the children chosen to participate in the program have learning difficulties or emotional problems and have found learning to read frightening and frustrating. Having the support of a dog and the

unconditional love it provides, is an enormous help in building the child’s confidence.

Story Dogs is a not-for-profit organisation that helps more than 600 children each week in 75 schools around Australia with more than 200 dog teams.

Pre-determined times for review

that provided by musculoskeletal physiotherapists, rheumatologists, psychologists, spinal surgeons, pain physicians and rehabilitation physicians.

This model of care outlines a prescriptive timetable of regular patient review until pain resolves or other treatments are invoked. After the initial visit, it is suggested review be undertaken within two weeks, then if required at six and twelve weeks.

It is recognised that in some cases pain may not completely resolve. In these circumstances, the aim will be for the coexistent resumption of pre back pain activities with improved function and self-management.

Adherence to the prescriptive timetable for regular patient reviews will ensure that best practice treatments are available to people in whom pain may persist. This also allows ongoing education strategies, reinforcing the evidenced-based messages, and reassurance for those with persisting LBP. Timely referral

Access to specialist care needs to be available once it is clear LBP is persisting in an individual despite appropriate interventions Specialist care may include

Summary

The core aim of the Model of Care for the Management of People with ALBP is to support evidence-based care. The key objectives are to improve the process of care as measured by compliance with Agreed Basic Care Standards while improving patient outcomes and satisfaction with care. The standards represent the key evidence-practice gaps noted in the management of ALBP. Agreed Basic Care Standards

1. Each patient is assessed – history, physical examination and when indicated a lower limb neurological examination 2. Each patient is triaged into: • Non-specific low back pain • Low back with leg

a publication of North Coast Primary Health Network

It costs approximately $500 per year to put a dog team into a primary school which covers the training of the dog and handler, professional assessment and accreditation of the dog, vet checks, dog vest with logo, insurance and books.

The Story Dogs program is always looking for volunteers and sponsors with school requests for dog teams growing. If you are interested in volunteering or sponsoring please visit the Story Dogs website – www.storydogs. org.au/ Sponsors have their name or company printed on the dog’s vest and sponsorship provides great media opportunities. The names of sponsors and their logo also appear on the web site and other promotional material.

3.

4.

5.

6.

pain • Suspected serious pathology No patient with nonspecific LBP is referred for imaging Each patient receives education about their condition that reflects contemporary treatment and self-management approaches Patient management is guided by an evidencebased practice guideline A follow-up review is scheduled for each patient.

Acknowledgements: The contents of this article has been selected from the ACI Model of Care for Acute low back pain which was written in conjunction with Professor Chris Maher, Manuela Ferreira, Niamh Moloney, Robyn Speerin and members of the ACI Musculoskeletal Network. Support from the ACI Pain Management Network is recognised. References available on request. healthspeak Summer 2016

What is?

O

ptometrists are health care professionals trained to examine the eyes and visual system. Optometrists diagnose, treat and manage diseases and injuries of the eye and associated structures. Optometrists are experts in the management of visual disorders, and in the correction of reduced vision.

Numerous systemic conditions affect vision or the ocular structures, so optometrists play an important role in identifying problems associated with general health disorders. Optometrists prescribe spectacles and contact lenses, medications

What is Optometry? for ocular conditions, vision therapy, and low vision rehabilitation.

Optometrists are registered health professionals. In order to practice optometry in Australia, a university degree in optometry must be held and optometrists must be registered through AHPRA. Australian optometrists' skills and procedures include: • Refraction: measuring the optics of the eye • Binocular vision tests: testing the co-ordination of the two eyes as a team • Ophthalmoscopy: internal

examination for eye disease • Slit lamp biomicroscopy: external, detailed examination of the eye • Tonometry: measuring the pressure of the eyeball • Optical Dispensing: supply and management of spectacles and contact lens Optometrists also develop and implement ways to protect workers’ eyes from occupational eye strain or injury.

Information taken from Optometry Australia website: http://www.optometry.org.au

Profile

Michael Jones, Optometrist, Coffs Harbour

ichael grew up in Canberra and was always interested in the health and science fields at school. In Year 10 he obtained work experience with an optometrist and found it ‘quite fascinating’.

“Plus the bonus was that you had to study in Sydney which meant I could get out of Canberra! I finished my Bachelor of Optometry in 1991 and have since obtained various post graduate qualifications in ocular theurapeutics (allowing me to prescribe topical medications) and more advanced contact lens fitting, I'm also a CASA credentialed optometrist allowing me to assess pilots and air traffic controllers,” he told HealthSpeak.

It was in Adelaide that Michael began his career working with a skilful optometrist who really took the young man under his wing.

“The mentoring I received early on was incredibly valuable and certainly pushed me to achieve a lot more. I'm now mentoring different optometrists in various stages of their career, mainly in speciality contact lenses, but also in business

from Kempsey and came back for a school reunion and convinced me that the Mid North Coast was the place to be! We have been here 15 years now. I am a partner in our current practice and she is the clinical lead for headspace in Coffs Harbour – we couldn't be happier.”

Michael is also heavily involved in Optometry through his professional association where he is on the Board of the NSW branch. He’s also NSW representative and Vice President of the national organisation Optometry Australia.

Witnessing clients improving their sight and function through speciality contact lenses is something Michael finds very rewarding.

“There was one case, a young girl who was 10 who had a corneal condition known as posterior polymorphous dystrophy which meant her vision corrected with spectacles was only 6/60 bilaterally. She had all sorts of low vision aids and teachers’ aides to help her.

After two months of constant visits and me having to lie on the floor while her Mum held

M

Summer 2016 healthspeak

and politics. “ After three years in Adelaide, Michael packed everything into a back pack and spent 15 months travelling through Mexico, Central America, South America and then through South East Asia. On his return he cut off his long hair and beard and went to work in Sydney with one of Australia’s leading contact lens experts.

“This is where I really discovered my passion for speciality contact lenses - mainly fitting special contact lenses for people with corneal diseases such as kerataconus and post corneal grafts.

“From there it was back to Adelaide where I met my wife Kristy who was doing her GP training. She was originally

a publication of North Coast Primary Health Network

her head to insert the lenses, she is now 6/9 in both eyes, performing brilliantly at school and playing sport constantly.

She's 18 now but still travels from Queensland to see me and gives me a big hug each time.

That sense of being able to help someone so profoundly with your expertise is what drives me to keep practising and get better,” said Michael.

While he enjoys his profession, Michael says there are certain pressures on optometry such as corporatisation, an oversupply of graduates and a lack of post grad placements.

“I urge all the new graduates that I speak to to get out into the country where there are still plenty of jobs and an enviable lifestyle. Working in rural areas also means that you get the opportunity to use your training to its full extent. This makes work incredibly rewarding as compared to being stuck in a shopping centre in suburban Sydney,” he added.

Michael is a partner at Russell Jones Kelly Optometry at 14 Arthur Street, Coffs Harbour.

Phone 6651 1139.

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Breast cancer support in Port Macquarie

T

he Port Macquarie Pink Girls group is a Facebook group for women living with and beyond cancer in the area of Port Macquarie. It started in 2013 with just a few members and now has 29 women. It is a private Facebook group. This means that no one outside the group can view comments or see who the members are.

While the group is for women only, occasionally events are organised where partners are welcome. Women with other types of cancer than breast cancer are also welcome.

Member Magalie Lameloise told HealthSpeak that Pink Girls share stories, questions and thoughts.

“We meet about once a month either for an early dinner on a week day or a Sunday breakfast.

The ladies from the group would like to encourage women in the local community affected by breast cancer to make contact and take advantage of sharing their experiences with others.

Our group is different to other Breast Cancer support groups

A

Tracy Stone, Michelle McClure, Suzanne Naylor, Toni Wright, Sue O’Bree, Jackie Brennan, Magalie Lameloise, CJ Grootenboer and Gai Henry.

as most of our women are still working or are at home with young families,” she said.

For more information contact Tracy Stone on 0411 027 171 or email: fourstonesinport@bigpond.com or Magalie Lameloise on 0406 430 384 or email magsblog@yahoo.com Magalie is also keen to promote the resources provided by Breast Cancer Network Australia (BCNA), a national organisation supporting people affected by breast cancer. “They work to ensure that Australians affected by breast cancer receive the very best support, information, treatment and care appropriate to

their individual needs.” she says.

Magalie has trained as a BCNA Community Liaison Officer and does volunteer work for the organisation to build awareness of breast cancer through sharing her personal story. She is also promoting the new range of support BCNA has: bilingual booklets and audio in English and other languages in order to provide accessible and appropriate information for women with breast cancer from diverse cultural backgrounds.

For more information visit www.bcna.org.au

Pregnancy and Diabetes

T

he National Diabetes Services Scheme (NDSS) has recently launched new resources on planning and managing pregnancy for women with type 1 or type 2 diabetes.

The NDSS Diabetes in Pregnancy National Development Program has developed resources to help provide information for women with type 1 or type 2 diabetes who are planning a pregnancy now or in the future, including: • www.pregnancyanddiabetes.com.au a website

30

50% of RACF residents have dementia

dedicated to pregnancy and diabetes information • Having a healthy baby booklets providing comprehensive information on planning and managing pregnancy. Separate booklets are available for women with type 1 or type 2 diabetes.

The booklets can be downloaded from www.ndss.com. au and www.pregnancyanddiabetes.com.au. Hard copies can be ordered by calling the NDSS Infoline on 1300 136 588.

a publication of North Coast Primary Health Network

web report, released by the Australian Institute of Health and Welfare (AIHW), looked at two aged care service streams: residential aged care and the Home Care Packages Program (where services are designed to support people to live independently in the community for as long as possible).

New data in Residential aged care and Home Care 2013-14, shows that 7.8% of the Australian population aged 65 and over were in residential aged care in 2013-14, and another 2.5% received a care package in their home.

“People in residential aged care generally had high care needs,” said AIHW spokeswoman Justine Boland.

“At 30 June 2014, 83% of people in permanent care needed a high level of carecompared with 76% in 2008.

More than half (52%) of all people in permanent residential aged care had a diagnosis of dementia,” she said.

People in residential aged care also had higher rates of dementia than the estimated prevalence rates for their age.

“For example, in the general population, 3% of people aged between 65 and 74 are thought to have dementia, but some 43% of people in permanent residential aged care in the same age group had a diagnosis of dementia,” Ms Boland said.

There were 173,974 people in permanent residential aged care at 30 June 2014.

Most (77%) were 80 years or older, and the average age was 84.5. Women made up 69% of people (119,577) in permanent residential aged care, and this disparity increased with age.

healthspeak Summer 2016

What do we want from our tax system?

T

here’s not much joy in paying tax.

Realistically though, most of us would admit we enjoy the benefits that government spending can provide – for example a defence force, policing, security, education, health, infrastructure and safety net for the less well off.

If we grudgingly agree some sort of tax is necessary, there are two main issues. How much and what form should the tax take?

It’s a question we are being asked to consider because the current system is not working at all well. A bad tax system can be costly, create distortions in the economy, provide disincentives to work, save and invest, encourage evasion and crime, exacerbate income inequality and lower economic growth.

The Federal Budget is in structural deficit at the same time as demands on the government are growing. Yet our population is aging, more people are retiring and in time there will be relatively fewer people in the workforce.

With a smaller percentage of the population working, average living standards will fall unless we can make the workforce larger and more productive.

Other challenges include rapid changes in technology, robotics and ever increasing globalisation.

It means we have to be adaptable, productive and smart. A good tax system is one ingredient that can make a difference.

With the Federal Government now keen to make changes to the tax system but without changing the amount collected, a step back from the minutiae might help. Generally economists say a good tax system has a number of characteristics.

relatively cheap to collect and it should minimise the way the tax affects people’s behaviour. A higher tax on say bread may cut the demand for bread and affect wheat producers, bakers and their workers. A tax does not just shift income from the taxpayer to the government, it can actually decrease economic activity making the economy worse off.

2. Any tax system should also be equitable. It should be fair in the sense that people in the same economic position should bear the same tax burden. More controversially, it should be progressive – the more you earn, the higher the proportion of your earnings that should go in tax.

3. Taxes should be simple and easy to understand and compliance should be easy.

Tax accountants ideally would not be required.

4. The tax system should be sustainable in the sense that it can respond to changes in the economy and to changes in demographics.

5. The system including transfer payments such as social security should be consistent and not contradict itself. For example social security payments should

provide incentives to work.

According to the 2010 Henry Tax Review (a comprehensive review that was basically shelved by governments), economic research has shown that a change in the tax mix, even without changing the total amount raised, can have very large benefits.

For example a shift away from income tax to a tax on immovable property (a land tax) could see gross domestic product increase by a massive 2.5 per cent.

A move from income tax to a consumption tax could increase activity by 0.7 per cent.

On the other hand a move from consumption taxes to corporate tax can decrease activity by more than two per cent.

Using the principles described above, a broad based consumption tax, for example, would have a smaller adverse impact than a more narrowly focused consumption tax because it could be levied at a lower rate. This means less distortion.

But a consumption tax is basically regressive – that is it hurts the poor more than the rich, ie it is not equitable. But with compensation for the poor, the tax can be made more progressive.

Generally high company taxes are seen as reducing economic activity. In a globalised economy, high corporate taxes

finance David Tomlinson encourage evasion and can force economic activity offshore.

The Henry review recommended that many taxes in Australia should be abandoned and that we should focus on four robust taxes that meet most of the aims of a good tax structure including efficiency.

These are: 1. Income tax that is restructured so it is on a more comprehensive basis 2. Business tax that is more growth orientated and has a better base 3. Consumption taxes that are simple and broadly based 4. Rent taxes based on resources and land.

Other taxes such as payroll tax, stamp duty, insurance taxes, fuel and excise taxes, taxes on superannuation and government social welfare payments should be abandoned. Some other taxes that efficiently meet other objectives such as tobacco and pollution taxes can be maintained. These taxes are deliberately aimed at altering people’s behaviour.

We have a long way to go in this debate and sound economic principles will be doing battle with political objectives. Hopefully we can all take a longer term view and sanity will prevail.

1. It should be efficient with two aspects. It must be Summer 2016 healthspeak

a publication of North Coast Primary Health Network

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Interactive tours for dementia patients O nce a month, Grafton Regional Gallery runs a morning coffee and art tour – Arts in Mind - for dementia patients and their carers.

The Gallery is housed in Prentice House, a federation residence with magnificent gardens. When HealthSpeak visited Arts in Mind it was a stunning sunny morning and around 25 people were enjoying coffee and biscuits in the sunshine of the garden courtyard.

The Gallery’s Development Officer Nardia Walters explained how the program began in 2011.

“The former Gallery Development Officer Rose Marin in collaboration with North Coast Dementia Outreach Service Coordinator Atosha Clancy came up with the idea to meet

Patients and carers appreciate the social time that Arts in Mind provides.

up with clientele on a regular basis in cafes, rather than doing house calls. From there Atosha thought it might be good to run

a Café Connections morning (as it was then called) at the Grafton Regional Gallery and Rose, who used to be in my position here

North Coast registrars are winners

N

CGPT Registrar Liaison Officer Dr Ashlea Broomfield was named RACGP Registrar of the Year at the GP15 in Melbourne in September.

And congratulations to another North Coast registrar, Dr Hannah Visser who was awarded the RACGP National Rural Faculty Registrar of the Year Award at the same event.

Ashlea, who’s from Woolgoolga and Northern Beaches Medical Centre, was recognised for her strong commitment to learning, the general practice profession and providing high quality patient care.

Presenting Ashlea with her award RACGP President Dr Frank R Jones congratulated her for her enthusiasm and dedication to providing better learning opportunities, fairer pay and better conditions for GP registrars.

“Dr Broomfield is an asset to general practice, her passion for education is outstanding

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Ashlea Broomfield

and she is highly regarded as a pillar of support and encouragement to her fellow registrars,” Dr Jones said.

“She has also been a great advocate for registrars at a state and national level and was recently elected as chair of the General Practice Registrar Medical Educator Network,” he added.

Hannah, who’s working at Casino Aboriginal Medical Service, won her award for demonstrated commitment to

Hannah Visser

rural general practice, learning and education and service to rural patients and rural communities.

The RACGP’s Dr Ayman Shenouda said Hannah would be a strong future leader in rural and remote general practice.

“Dr Visser has shown an outstanding commitment, dedicating over two years working in North Coast GP Training’s most difficult to staff areas,” she said.

a publication of North Coast Primary Health Network

at the Gallery, took it on. Atosha and Rose thought having the art element thrown in would be a good thing, and so Arts in Mind was born.”

Sadly, the Gallery’s café closed last year, however happily Nardia was recently informed

by Clarence Valley City Council that the café is being reopened.

Today Tracy Pateman who is studying at post graduate level memory loss and art therapy is also visiting Arts in Mind with a view to perhaps commencing an art workshop for dementia patients and their carers. Nardia explained that there is a section of the Gallery which could be used as a workshop/studio for such ventures.

According to Nardia, Arts in Mind offers as many benefits for carers as for the patients.

“They are quite interested in what exhibitions are on and they can look around while some of those with dementia struggle more with getting up and looking around. But both patients and carers also just appreciate the social time with people in similar situations.”

Art tutor and educator Bernadette Trela and former Cranes employee Libby Shearer act as guide and ‘wingman’ for the tours and encourage people into the Gallery to look at various art forms and engage in discussion with patients and carers about the art.

“Today we have an exhibition of beautiful bird drawings fro the gallery’s collection by Doris O’Grady. Some of the patients have been saying that they knew the O’Grady sisters, so often there’s some connection with the artists or art work that starts up a conversation,” Bernadette said.

Speaking with patients and carers as we move around the Gallery, it’s clear that Arts in Mind is an important monthly event for them and it’s a program that is ripe to be instituted in other council areas. healthspeak Summer 2016

Meat and three veg I

n the middle of writing this article about food, the newsflash that stunned the world community arrived, about the terrorist murders in Paris.

‘Nous sommes Unis,’ the world shouted back.

The piece I was writing was about the modern obsession with perpetual personal preservation, staying alive and well into old age. In the light of this event, writing about the effect of diet in the western quest feels like a pander to the cossetted and worried well.

Everybody I talk to seems to be knocked sideways off their perch by this particular atrocity.

Daesh or ISIS, whoever they are, pass harsh judgement on our way of life. How this outfit can brainwash their foot soldiers into such murderous self-immolation is beyond understanding in a society so immersed in the pursuit of happiness and life quality. Prime Minister Keating said that ‘In a race of two horses, self interest always comes in first’. So it’s back to the long healthy life and talk about food.

In an historical perspective, Australians and Europeans and Americans are living longer than at any time in human history.

Eighty is a not an unreasonable expectation for many. A Roman citizen was lucky to make 35 and as recently as the early 20th century, life expectancy was 45.

An unhappy spinoff from the current longevity bonus is the rise in cancers, degenerative and cardiovascular disease. How preventable are these conditions?

Obviously medical science and public health have played a large hand, though not so long ago, even during my time at medical school, doctors were confined to treating, occasionally curing illnesses while virtually ignoring lifestyle factors now recognised as preventative medicine.

In the medical curriculum of the late 1960s, it’s hard to Summer 2016 healthspeak

remember any lectures at all about diet, though the words of one wily biochemistry teacher slipped in, make sense years later. Dr Bill Hensley, during talks about the incomprehensible Krebs liver cell cycle, interspersed a few practical comments. ‘Sugar,’ he said one day ‘is as natural to the body as smog’.

Another one, ‘Breast milk is for babies. Cow’s milk is for calves’.

Another. ‘If the Aboriginal tribe inhabiting Sydney had eaten as much meat as Europeans today, they would have needed a hunting ground the size of NSW. Dr Hensley was seriously ahead of his time. Yogurt had yet to appear. Olive oil was available only in the form of Faulding’s Medicinal, as the Italian greengrocer, who used it in his cooking, informed me. Veganism was unheard of and three veg without meat was not even up for discussion. Yoga (navel gazing) was considered heathen.

I recall an early breakthrough, first introduced by the European immigrants, as students flocked to the eating discovery of the Costa Brava, a sleazy Portuguese restaurant in Sydney, serving garlic prawns on an iron dish sizzling in hot oil.

Telegraph through time. A dinner hostess recently commented, ’It’s all too difficult.

People with dietary requirements just don’t get invited’, as she served a chicken hotpot with everything. Recent research has named red meat as carcinogenic.

Vegans and animal liberationists are saying I told you so. Another recent finding is about coffee, now considered beneficial.

When I first started practice in Mullumbimby in 1975 I received an invitation to a barbeque on a hippy commune and turned up with sausages, as one does. I was surprised when asked not to put my dead animal on the main cooking fire and that I would have to make my own fire over there somewhere.

My sheepish feelings were soon dispelled by the appearance of a dozen kids and their dogs drawn by the smell of cooking sausages.

Maybe laughter is still the best medicine.

light airs David Miller

‘Sugar,’ he said one day ‘is as natural to the body as smog’.

Another one, ‘Breast milk is for babies’. Cow’s milk is for calves’.

a publication of North Coast Primary Health Network

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Keeping kids in mind

By Amanda Shoebridge Marketing and Communications, NRSDC

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tatistics released this year sent a shiver down the spine of parents and carers. The largest survey undertaken into child and teenage mental health in Australia conducted by the University of Western Sydney found that around 560,000 children had experienced a mental health disorder during the past year. Alarmingly, one in 13 children aged between 12 and 17 had seriously considered suicide. One in 20 had chosen a place to do it.

“Mental health difficulties formed early in life can persist into later life”, said Deb Hall, Manager of Child and Family Programs for the Northern Rivers Social Development Council (NRSDC).

“What this research also highlighted is the dearth of services and supports for children suffering mental health issues.”

It is this gap which Mijung Jarjums Kids in Mind, with offices in Lismore and Casino, hopes to help close. It’s an early intervention service which takes a trauma informed, holistic,

Sarah Daley, Terese White, Deb Hall and Jindeena King from the NRSDC Mijung Jarjums Kids in Mind program.

strengths based and personcentred approach.

“While fewer children are reporting with ADHD, examples of depression and anxiety disorders are on the rise. Mijung Jarjums Kids in Mind has a crucial role to play where children are at risk of a mental illness,” explained Deb. “We can work with kids, young people, parents or carers to address these concerns and to build upon the child’s individual capacity.”

Ice workshop in Lismore

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n late November, The North Coast Primary Health Network in partnership with Bulgarr Ngaru Medical Aboriginal Corporation held a practical one day training in methamphetamine treatment for 40 specialist Alcohol and Other Drug Workers.

The Breaking Ice workshop aims to improve 34

counselling skills when dealing with methamphetamine users.

Topics covered included the effects of methamphetamine on the brain and consequences for treatment and how to apply an evidencebased four-session Cognitive Behavioural Therapy program and a motivational interviewing intervention.

Interventions include individual case management where Child and Family Workers engage directly with the children as well as parents, carers and educators as well as short term support within the community services and health sector.

Mijung Jarjums Kids in Mind also provides training for parents to recognise the signs of mental illness and where to seek help, as well as providing workshops and sessions for children in schools and playgroups.

From page 19

The clinic’s ultrasonic debriding machine is attracting referrals from up and down the coast including the Gold Coast, Tweed and Lismore hospitals and from surrounding GPs. Gerard said that getting such a range of referrals was a new phenomenon.

“That hasn’t happened in the past, but it’s changing. I think there’s more networking these days and HealthSpeak magazine has been a great help. Traditionally, people have been very protective of their boundaries, but a publication like HealthSpeak can link people up and let practitioners know who’s doing what. What’s changed is that it’s no longer just about the practi-

a publication of North Coast Primary Health Network

“We provide the kids with opportunities to develop their emotional language, mindfulness techniques and strategies around emotional regulation – helping them to identify their feelings and emotions, and where they feel those emotions in their bodies”, said Deb. Simple practices are introduced to help reduce heightened levels of emotion or stress. Kids in Mind also helps kids see their situation with a healthy perspective and allows them to talk about things in a safe environment.

Eligible participants are children and young people aged 0-18 years showing early signs of, or are at risk of mental difficulties, their families and carers within the Richmond Valley and the hinterland.

Children can be referred by GPs, health professionals, community referrals or by self-referral. For further information visit www. nrsdc.org.au or phone 02 6620 1896. Mijung Jarjums Kids in Mind is delivered on the North Coast by the Northern Rivers Social Development Council.

tioner, it’s about the patient.”

The Tweed Super Clinic Wound Clinic operates four days from 8am to 5pm but often the hours are extended due to demand. Soon the Wound Clinic will operate five days a week and hoping to employ another wound care specialist.

“The Super Clinic Wound Care Clinic is a wonderful place for nurses to get more education in wound care and hands-on experience while studying,” said Gerard.

With around 465,000 people experiencing chronic wounds in Australia each year, wound care is a burgeoning health area.

Contact Gerard Robards on (07) 5589 7555. healthspeak Summer 2016

Honour, Duty, Courage Mohamed Khadra William Heinemann 249pp

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his is an unusual, inspiring and harrowing book, the first quality deriving from being billed as “non-fiction” despite the action taking place in a country with the fictional name of Equatoria, and the characters being invented ones.

The author’s justifiable explanation is that he interviewed a large number of Australian medical professionals who had served abroad on military and humanitarian missions. They spoke on the basis of not being named, and judging by the result, were far more forthright than if they had been contributing to a truly factual work.

Moreover, they were serving officers in such settings as East Timor, the tsunami aftermath in Aceh, and the Balkans, and remain subject to military codes of confidentiality.

As a result, the interviewees and their stories are turned into composites that make for a believable and dramatic “novel”.

“Among my colleagues in the medical profession are doctors who, in addition to their daily toil against disease and suffering, serve our nation through military postings,” Dr Khadra explains.

As well as authoring three bestselling books with medical themes, and co-authoring with David Williamson the end-oflife play At Any Cost?, he is a surgeon in Western Sydney, a prizewinning researcher and an academic of note. Now, we learn he can turn out a riveting pageturner as well.

“These doctors and nurses do not discriminate between friend and foe,” he adds.

“With their teams of support staff, they set up forward surgical units, field hospitals, operating theatres, intensivecare units and wards wherever the national interest decrees that our presence is needed - often in desolate, forsaken places.”

Summer 2016 healthspeak

book review Robin Osborne One such is the evidently African country of Equatoria, a place where ruthless troops employed by a corrupt government are engaged in a civil war against brutal rebel forces… think machetes, child soldiers, IEDs, mass rape and the ghastly disfigurement of civilians.

Into this mix comes an international peacekeeping force comprised largely of French troops, and as soon as it can be established, an Australian field hospital, unnervingly close to the frontlines.

Getting the call to deploy to this nightmare are anaesthetist Tom McNeal and his close friend and colleague, vascular

Both men have a fundamental ethos of service to others, and they saw the army as a natural extension of that duty to humanity

surgeon Jack Foster, who often work together at the Victoria Hospital “as a dynamic team with a reputation for saving the unsaveable.”

Their challenges include interpersonal rivalries in the surgery department, and the struggle to deliver patient services within operating budgets set by bureaucrats. Pressure at home comes from wives who continue to sacrifice much of their social life to their husbands’ on-call duties.

On top of that, both are army

medical reservists: “Both men have a fundamental ethos of service to others, and they saw the army as a natural extension of that duty to humanity and to country.”

This commitment will be sorely tested when they fly into Equatoria on a C130 flight that zigzags through ground fire to land at a tent city where nurses and paramedics at a wellequipped field hospital await the arrival of doctors before they can begin treating the many wounded requiring care.

“We’re not a tertiary referral hospital,” says the gruff CO. “Our job’s simple: get ‘em stable and ship ‘em out. There’s no time for rehabilitation or anything fancy.”

The cases they see will challenge them as never before, while the events they experience - clearly based on the stories told to Dr Khadra - will distress them deeply.

One of the worst is the German nun, captured by the rebels, raped, then opened up and a pressure-sensitive explosive

a publication of North Coast Primary Health Network

device sealed into her abdomen. Left at the compound’s doorstep, she is literally a human bomb who must be sedated and reopened by the doctors before a bomb disposal expert can safely extract the device.

During their tour of duty, many lives from both sides are saved, while others cannot be.

When the harsh demands of field triaging result in the death of a badly wounded French soldier who might have survived, a damning letter from his sister, a doctor herself, adds to the two men’s strain.

Amidst the horror there is plenty of good humour, thanks to the supportive team of junior doctors and experienced nurses, and the seasoned Aussie soldiers who provide protection. Trading croissants and champagne from the French camp is one highlight.

A tragic twist at the end is a reminder of the dangerous world that medical volunteers encounter, and heightens the impact of a tale that deserves to be widely read.

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Tweed Palliative Support wins top awards

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regional cancer support and palliative care charity has won 2015 Best Community or Social Service and the top 2015 Best Business in Tweed Award at Tweed Shire’s Business Excellence Awards.

Tweed Palliative Support (TPS) is a not-for-profit group run largely by volunteers and recently opened NSW’s only community hospice for children and adults, Wedgetail Retreat.

Established in 1998, TPS provides free home-hospice support, respite and hospice nursing care, educational courses and Sunshine ‘Pamper’ Days for people living with cancer or a life-limiting illness and their family.

Panel judge, BEATS Coordinator, Natascha Wernick, explained why TPS won the top award: “The Southern Cross University judging panel felt that the TPS application strongly presented the successful and inspiring

volunteer training, education and Sunshine Day support.

“We are not as yet government funded and we continually need donations, business sponsors, bequests and patronage of our Murwillumbah Op shops in order to continue our free services,” she said.

From left: Tess Thompson, Sue Evans, Deirdre Stewart, Liza Nagy & Meredith Dennis with the Top Business award.

events, partnerships and advocacies achieved throughout the previous year, as well as the enormous fundraising efforts undertaken, including the operation of their Murwillumbah Op shops to be able to open one of NSW’s first community hospices, Wedgetail Retreat, in February 2015.

Tweed Palliative Support generates a tremendously good feeling in the community through their free cancer support and palliative

care services. A very deserving category and overall winner,” Meredith Dennis, TPS President and Volunteer Coordinator said the team was thrilled to have won its category and honoured to be named ‘2015 Best Business in the Tweed’.

“We work in partnership with the local health service, as well as the state and national palliative care organisations to offer home hospice, live-in hospice,

Travel ‘superbugs’ add to infection risk

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ravellers exposed to antibiotic-resistant bacteria may force a change to common medical procedures that rely on effective antibiotics, say researchers from The University of Queensland.

Researchers from UQ Centre for Clinical Research urge patients to disclose recent overseas travel to their doctor before undergoing procedures involving the urinary tract, as they could be at increased risk of infection.

Infectious Disease Physician and Microbiologist Dr Patrick Harris said the increase in international travel and over-use of antibiotics were creating a global spread of multi-drug resistant bacteria including E. coli and Klebsiella pneumoniae, which commonly cause UTIs. “Following overseas travel to endemic areas, resistant bacteria 36

strains can live quietly within our bodies undetected without any symptoms for months,” Dr Harris said.

“If you then develop an infection, the risk of this being caused by bacteria that can resist antibiotics is much increased.”

“Patients undergoing prostate biopsy for cancer detection, receiving a long-term urinary catheter to relieve bladder obstruction or a kidney transplant are at an increased risk, because such procedures rely on effective antibiotics to either prevent

or treat infections should they arise. Worst-case scenario, an infection that cannot be cleared by antibiotics can result in multi-organ failure and this can be fatal.”

Men who have travelled or used antibiotics between six and 12 months before a prostate biopsy should inform their urologist, as additional tests or treatment may be required. Such drug-resistant strains are also increasingly seen in nursing home residents or those with previous exposure to antibiotics.

Microbiologist, Professor Mark Schembri from the UQ School of Chemistry and Molecular Biosciences says novel techniques may prevent recurrent UTIs and catheter-associated UTIs, while new approaches to prostate biopsy may reduce infectious complications.

a publication of North Coast Primary Health Network

Pharmacy supports Section 100 changes

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he Pharmacy Guild of Australia is pleased to support the NSW Government’s commitment to paying the patient co-payments for Section 100 (s100) Highly Specialised Drugs.

This commitment was made in March 2015 to help ease the financial burden for those in the community who have some cancers and other chronic conditions.

From 1 October 2015, co-payments for Section 100 Highly Specialised Drugs will be paid by the NSW Government for NSW residents, who are patients of NSW public hospital or authorised community prescribers in NSW. In the initial roll out of the system, the NSW Government will pay the co-payment for HIV antiretroviral therapy, Hepatitis B medicines and clozapine dispensed in the community pharmacy setting.

Further information can be found on the NSW Health website at www. health.nsw.gov.au/ pharmaceutical

healthspeak Summer 2016

Appreciating the music of wine

wine Chris Ingall

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ine, women and song’ is a phrase attributed to Martin Luther which was turned into a song by Strauss and finally appropriated by AC/DC in their High Voltage album in 1976. I have often felt there is a great simpatico between wine and song, while the third side of the triangle remains a great mystery, albeit offering equally pleasurable company. Wine is one of the great civilisers of the modern age, as Thomas Jefferson noted when he offered ‘no nation is drunk where wine is cheap’. Along with song it offers a great balm to the soul, and it is worth noting their similarities.

Many wines are so-called single varietals, such as most of the wine we see advertised as shiraz.

As an aside, it is worth noting up to 15% of such wine can be other varieties, usually cabernet sauvignon, sometimes grenache and less commonly viogner, without needing to acknowledge this on the label. (Even Grange has a good dollop of cabernet most years). Pinot noir is not uncommonly blended with a little shiraz, and so on it goes.

The mirror to this in the world of music is a tour de force from a single instrument, such as a piano. Whilst satisfying in themselves, the bell notes of a single varietal or instrument often leave me wanting a little more, something composers and winemakers have also responded to.

Next in line would be blends where there is a clearly dominant grape, such as cabernet sauvignon’s place in the blends of the left bank of Bordeaux, or merlot on the opposite side of the river.

This is similar to the concertos in the world of music where a single instrument is complemented by the various pieces in the orchestra, in a symbiotic relationship.

Summer 2016 healthspeak

Finally you come to wines such as Houghton’s White Burgundy which is an almost equal mixture of a number of white varietals, each giving a slightly different nuance to the wine and peaking in their importance at different times along its life, the chardonnay component early on and the chenin blanc after five to 10 years.

Red wines such as the lovely GSMs from the Barossa and McLaren Vale also offer a combination of many different types of varietal, some from the old world and some from the new. The grenache provides lighter, red fruit flavours as well as perfume and spice; shiraz contributes richer fruit flavours and struc-

ture; while mataro brings earthy and spicy elements and texture to the mix. The three varieties often seamlessly mesh together as a complete blend. Now we are talking about an orchestra of flavour, chamber variety in the lesser wines and symphonic in the greater ones, and like an orchestra the sum is greater than the parts.

Moving away from the structure of both wine and music to the more romantic notion of how it makes us feel, I would argue there are even greater parallels.

Who has never found themselves lost in the enjoyment of a bottle of wine or of a great piece of music. It is one of the great ‘out of body’ experiences of our time and it is relatively free from cost or consequence. While some would say a hangover is a high price to pay, I would of course suggest music should be listened to in moderation.

The excitement of drinking a beautiful aperitif champagne or scintillating rosé with friends on a warm summer’s day, the warming of the soul of a beautiful shiraz or the wonderful calming feeling of sipping a sauterne over dessert, these are all emotional journeys also found in the world of music. When they come together, particularly with friends, there is not much to beat it.

Of course the colour of the drop influences our emotions as well. The strength and warmth of red imbued with the spirituality of purple, the harmony of green tempering the bright optimism of yellow. Similarly the major and minor chords lead our emotions at will. So the next time you sit down with friends over a bottle of wine, with your favourite music playing, do yourself a favour and take the time to stop and really look at the colour of the wine. Just another way to maximise your enjoyment! (This is why the manufacturers of psychoactive medication are so careful about the colour of their pills).

a publication of North Coast Primary Health Network

The strength and warmth of red imbued with the spirituality of purple, the harmony of green tempering the bright optimism of yellow.

Wine Tip If you are feeling a little low, try a glass of young semillon or riesling; the green and yellow hues will ensure the wine will lift your spirits. Similarly if your nerves need settling a glass of old red will do the trick, I promise.

Cellar Tip Coming into summer, put as many of your bottles into cardboard boxes as you can. 2mm of compressed papyrus will be 80% as good as polystyrene in keeping your wine at a steady temperature, and save you a motsa in air conditioning. A cardboard box and a Stelvin (screw cap) closure will be enough to see your wine goes the distance!

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Celebrations for new Winsome clinic

From left: NCPHN’s Jane Conway, The Winsome’s Mieke Bell and NNSWLHD community nurse Bronwyn Browne.

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n Saturday 17 October, The Winsome/Lismore Soup Kitchen hosted an event to celebrate the opening of the new clinic rooms at The Winsome and the renovation of the kitchen area.

The Winsome was keen to publicly thank North Coast Primary Health Network (NCPHN) and Vinnie’s for their joint funding of the construction of the new rooms and Northern Rivers Community Foundation for their funding of the kitchen upgrade.

The new rooms comprise a nurse’s room, a GP room and a waiting/reception area and are lo-

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App: diabetes guide Diabetes Australia has produced a phone app that provides patient-centric information for people living with diabetes.

It aims to be a pocket guide, offering news, recipes and directories. The app has six menu items: News, Recipes, Wellbeing, Events, Buy and Services. It also provides details of GPs and allied health providers within a given radius.

The app is free and is compatible with iPhone, iPod touch, iPad and Android

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cated on the ground floor of The Winsome. The clinic commenced in April 2013 and was operating out of the night manager’s bedroom in the residential area on the 2nd floor, with the nurse working out of an alcove in the hallway and the waiting room located in the residents’ lounge room.

Winsome management and clinic staff are thrilled with the new rooms which provide greater access, privacy, respect and dignity for The Winsome patrons and residents who attend the clinic.

The rooms also provide premises for other health services, such as a podiatrist, women’s health nurse and a mental health worker. They can also be used by The Winsome management and staff and any of the other community services providing regular outreach at The Winsome who need a quiet, private space for talking with people.

The clinic is staffed by a NNSWLHD Community nurse Bronwyn Browne, local GP Timon Jansen and NCPHN program officer Jane Conway and is supported by Vinnie’s Outreach Worker Bryan Jamison. It operates every Wednesday morning.

Lismore Mayor Jenny Dowell, State MP Thomas George and former Federal Member for Page, Janelle Saffin attended the event.

NCPHN Chief Exexcutive Vahid Saberi and NNSWLHD Chief Executive Chris Crawford were also present.

Tune In & Chill Out success

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n late October headspace Tweed Heads’ Youth Advisory Group presented a special beachfront event at Kirra to raise community awareness about headspace and to mark Mental Health month.

The day long Tune in & Chill Out event had something for all ages with a community barbecue, a cupcake stall run by volunteers, face painting, a hacky sack competition and a brilliant performance from local hip hop crew Phenom.

Local celebrity Rowdy, the author of Play a Bigger Game, supported MC Ren to ensure the day ran smoothly. To illustrate the impact of mental health issues, the crowd also heard personal stories from Tweed Coast Banana Queen Brooke Magnum and Youth Advisory Group members Ren, Zane and Keiah. Other performers included singer Xanthe Lees and local favourites Crown the Humble headspace Tweed Heads’ Youth Advisory Group are thrilled at the success of Tune In and Chill Out and will be planning future events to break the stigma associated with mental health issues.

They wish to thank headspace’s clinical receptionist

Youth Advisory Group Vice President Renee who was also the MC for the event.

Summa Hicks for her incredible event planning skills which resulted in such a successful day.

In other news, headspace Tweed Heads was voted favourite not for profit organisation in the region and received a cheque for $2500 for the win.

Thanks are also due to Cabarita Beach Retro Surfing Tournament for its $7000 donation to headspace Tweed Heads and also to Tweed Coast Banana Queen Brooke Magnum for her kind donation.

Experts applaud fluoridation

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ealth experts have welcomed the introduction of fluoride into the water supply in Lismore, Ballina and surrounds.

During the campaign to introduce fluoride to these towns, Lismore paediatrician Dr Chris Ingall told Fairfax News that the rate of dental decay in the region was ‘extremely high’, especially among children from lower socio-economic backgrounds.

a publication of North Coast Primary Health Network

Lismore dentist, Dr Brendan White, who is also president of the North Coast Division of the Australian Dental Association NSW, said within five years there would be a noticeable decline in tooth decay in the newly fluoridates areas.

However, he cautioned that fluoridation wouldn’t replace the need for good dental hygiene – brushing twice daily and regularly flossing the teeth.

healthspeak Summer 2016

Unnecessary elder meds

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ustralian researchers are urging GPs to consider deprescribing after finding that 80% of elderly patients’ medications may be unnecessary or harmful.

In a randomised controlled trial involving 100 residents of four aged-care facilities in WA, researchers were able to reduce the average number of daily medications from 9.5 to seven over a 12-month period.

Local GP Dr Kathleen Potter, and geriatricians at the University of WA, reviewed participants’ medicines and found that an average of eight out of 10 did not have a clear indication, were

not providing benefits or were causing adverse effects.

An example of inappropriate drug use was aspirin for primary prevention of cardiovascular disease in elderly people with no cardiovascular risk factors and a history of nose bleeds, said Dr Potter, who presented the findings at the RACGP’s annual conference last week.

The unpublished study found deprescribing did not reduce the number of falls, fractures, hospital admissions or cardiovascular events.

But Dr Potter said the small number of trial participants, who had an average age of

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84, made the results hard to interpret.

Previous estimates suggested about 30% of hospital admissions in people over 75 were drug-related, said Dr Potter, who recommended regularly reviewing elderly patients’ medications.

“We’re actually causing problems by giving people a lot of medicine. When you are renewing scripts for an elderly person, even if they have been on the same medication for a long time, think about it — is this necessary? Is this helping the patient, or could it be harming them? Do they still need this?”

GPs Required – Busy Medical Centre – Grafton (NSW) O Plus Health Medical Centre has been offering quality bulk billing medical and allied health appointments to the people of Grafton since March 2015 and now we have a 5 day waiting list.

We are looking for GP’s (VR/Non-VR, F/T or P/T) to join our 2 doctors (Female and Male) to assist in delivering high quality care focusing on positive patient outcomes. Located within Grafton Shopping World we now have an extensive waiting list for our team which includes allied health, registered nurse and administrative support staff.

Generous percentages available for full time or part time GPs. Please do not hesitate to contact us on 0433 138 227 or stacy@hmedconsult.com.au for a very confidential discussion.

A prescripton for Tai Chi? Tai Chi is a suitable exercise for older people with conditions like arthritis, a study has found.

The ancient Chinese art improves physical performance and enhances quality of life, say researchers. Tai Chi combines deep breathing and relaxation with slow and gentle movements.

The study, published in the British Journal of Sports Medicine, suggests the exercise helps with pain and stiffness in arthritis. It can also help improve quality of life in the lung condition, chronic obstructive pulmonary disease (COPD).

Advertise in HealthSpeak HealthSpeak is the perfect place to let the north coast health community know about your practice, company, rooms for rent or anything at all!

Display advertising is attractively priced. Simply email the editor to get a copy of our rates at: media@ncphn.org.au

OFFICE SPACE WANTED Expressions of Interest sought

GP for Lismore AMS Jullums, Lismore Aboriginal Medical Service, is seeking a motivated & experienced GP to join its team on a contracting basis 3 or 4 days a week, from January 2016.

Remote Vocational Training Scheme Ltd is seeking office space in Port Macquarie for staff member recently relocated to area.

Ideally within allied health provider or general practice.

Please contact Clara Smith 0487 235 538 csmith@rvts.org.au

Practice hours are 8.30am to 5pm, Monday to Friday and admin support is provided. Comfortable rooms close to Lismore Base Hospital and professional development opportunities.

Full professional registration, medical indemnity insurance, a current Working With Children clearance, ABN and eligibility to claim Medicare rebates are required.

For more information contact Christine Wilson on 6621 4366 or email cwilson@ncphn.org.au

Summer 2016 healthspeak

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a publication of North Coast Primary Health Network

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