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ISSUE 4 winter 2013

HealthSpeak A publication of North Coast NSW Medicare Local

www.healthynorthcoast.org.au It’s all about health page 5 page 15 4

Public dental services

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Healthy Pathways

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Launch of ACE

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GP workforce research


It’s all about health Janet Grist Head Office

Editor

Suite 6 85 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Vahid Saberi Email: enquiries@ncml.org.au Hastings Macleay 53 Lord Street Port Macquarie 2444 Ph: 6583 3600 General Manager: Paul Ward Email: hm@ncml.org.au Mid North Coast Suite 2, Level 1, 92 Harbour Drive Coffs Harbour 2450 Ph: 6651 5774 General Manager: Sandhya Fernandez Email: mnc@ncml.org.au Northern Rivers Tarmons House 20 Dalley Street Lismore 2480 Ph: 6622 4453 General Manager: Chris Clark Email: nr@ncml.org.au Tweed Valley Unit 4, 8 Corporation Circuit Tweed Heads South 2486 Ph: (07) 5523 5501 Acting General Manager: Wendy Pannach Email: tv@ncml.org.au

Contacts Editor: Janet Grist Ph: 6622 4453 Email: media@ncml.org.au Clinical Editor: Andrew Binns Email: abinns@gmc.net.au Display and classified advertising at attractive rates HealthSpeak is published four times a year by North Coast NSW Medicare Local Ltd. Articles appearing in HealthSpeak do not necessarily reflect the views of the NCML. The NCML accepts no responsibility for the accuracy of any information, advertisements, or opinions contained in this magazine. Readers should rely on their own enquiries and independent professional opinions when making any decisions in relation to their own interests, rights and obligations. ©Copyright 2013 North Coast NSW Medicare Local Ltd Magazine designed by Graphiti Design Studio Printed by Quality Plus Printers of Ballina

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There are times in our lives, notably as we get older, when we seem to be surrounded by friends and relations deal-

ing with serious illness. For me, these situations remind me to be grateful for my vitality and mobility, and to work on ensuring I remain healthy and active. If you are looking for a site that you can rely on for informed health and fitness information, get acquainted with North Coast Medicare Local’s new community website ‘Healthy North Coast’. It’s full of solid, reliable health information in an understandable form

for the community. It’s a one stop shop for anything to do with health on the North Coast. Launched on May 8, its Facebook page is racking up ‘friends’. I invite you to visit and ‘like’ Healthy North Coast on Facebook and encourage your friends to check out what this new social media platform offers for them. You’ll be surprised at the breadth of information on this new hub, which continues to grow.

Introducing Healthy North Coast Vahid Saberi Chief Executive Officer

A few weeks ago I was a tourist in Jerusalem. I went to the information centre seeking maps. I was asked if I carried a smart phone with me, which I did, and was then asked to download an application. This application, “Jerusalem old city”, was like a 24/7 well-informed, courteous, low maintenance, tour-guide. It showed me video clips, provided audio narration, pictures and information on every historical event and site in Jerusalem. This is a small example of how technology and social media is changing our world. In an age where we travel at the speed of sound and communicate at the speed of light, there will be a deep and wide impact on how we access health information and provide health care. All indications are that the first source of health information for most of us today is online. The great advantage of this is, of course, its ready availability – information anytime and anywhere. The popularity of many sites – you probably have your

favourites – is a testimony to this trend. In my view this is a good thing. The evidence is that while the community uses online sources to gather information and better understand a condition, when it comes to treatment, a consultation with a qualified clinician and medical professional is what we turn to. So how do we on the North Coast engage with, and inform the community, patients and clinicians? When North Coast Medicare Local was consulting, a key issue raised with us was the confusion of too many sites. We were asked whether it was possible to have a single site or social media platform providing most of the information we need and one that we can communicate through. In response, and through working with many collaborators, the online community health hub, Healthy North Coast, was created to support everyone to get healthy and stay healthy (www.healthynorthcoast.org. au).  Healthy North Coast is ‘all about health’ and contains accessible, easy to understand, and, most importantly, reliable and up-to-date health information. Its local focus means that people can find local information – gyms, tips on healthy eating or how to access a health service all in the one place. Healthy North

Coast is more than just a website, it’s a community of organisations, health practitioners and consumers collaborating to share high quality health information with the community via the Internet and social media platforms, including blogs, youTube, Facebook and Twitter. In terms of patient care also, there are wonderful technologies on the horizon that will change how we view and deliver treatment, such as connecting to patients remotely through mobile health monitoring devices. One example of this new wave is a health monitoring device that sends your vital health information (customised to you) to your GP periodically. Over the next decade or so this will become more and more prevalent. This brings me to another issue, which we can discuss another time – that is the number of GPs on the North Coast compared to State average. A fortnight ago, NCML was approached to provide information on health workforce on the North Coast of NSW. Through this process my attention was drawn to the number of GPs, which I always knew to be lower than the state average. However, the fact that NSW averages 309 GPs per 100,000 population and the North Coast averages 120 GPs per 100,000 did come as a surprise.

HealthSpeak is kindly delivered by HealthSpeak

winter 2013


The obesity blame game

Over the last few decades there have been plenty of theories put forward for obesity rates reaching epidemic proportions throughout the developed and rapidly developing nations. Most of them have some scientific research to back them up, but that is not always the case. The recent well publicised case of a GP with a special interest in nutrition and environmental medicine being sued by his patient for failing to refer him to a weight loss clinic, or for bariatric surgery, has brought a new twist to the blame game. As a result of his morbid obesity he now has advanced liver cancer. The concern around this case has been shared by GPs and health authorities who would no doubt be relieved now this case has been overturned in an appeal. The consequences of it succeeding would have been an enormous burden on the health system. GPs would have been forced to practice defensively, thereby dramatically adding to costs. They would have been influenced to do a lot more referring to specialist weight loss, obesity and bariatric surgery clinics. This may already be happening as a result of the publicity surrounding this case in the medical and broader media. This is all aside from the issues of access. What about the rural and remote regions where such services do not exist? What about the most disadvantaged in our community? They would not only be unable to afford the private services on offer but even the inadequately resourced, overload-

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ed public services would be hard to access because of transport, accommodation costs etc. And would people in rural and remote regions choose or be motivated to comply with the recommendations from these services? Disadvantaged people have high rates of obesity. Social determinants of health are often what matters most, not what new surgical techniques or far away clinics may have to offer in addressing their health needs. GPs and their allied health colleagues are at the forefront of supporting obese people deal with the prevention and management of the chronic diseases resulting from being obese, as challenging as this may be. And what about the never ending thorny issue: is obesity just a matter of self inflicted ‘sloth and gluttony’ for which an individual should take the blame? Or is it more to do with the environment we live in with ready access to energy dense food, cars and other physical energy sparing technology, widening socioeconomic inequality etc? Or maybe it’s the fructose in soft drinks, too much fat or high GI carbohydrate in our diet, portion sizes too big, too many TV ads promoting junk food aimed at children etc? All such things are no doubt of some relevance. Blaming GPs, chocolates, computer games, lack of self control or whatever for a complex matter like obesity is a futile exercise. Maybe there would be more benefit in encouraging and promoting lifestyle behaviour change, reducing our carbon footprint by purchasing our food

from farmers markets where possible, walking or cycling more, advocating for a more equal, educated and fairer society politically, promoting social cohesion etc. These sorts of measures may do more to address the obesity problem than courtroom rulings directed at GPs.

Opinion

Andrew Binns

Blaming GPs, chocolates, lack of self-control for obesity is futile.

Further reading: Planet Obesity, Garry Egger & Boyd Swinburn. Allen & Unwin 2010.

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After hours GP Helpline campaign North Coast NSW Medicare Local continues to work with general practices across the North Coast to increase access to after hours primary care. In addition to face to face services, the after hours GP Helpline, run by Healthdirect Australia, is proving to be an effective adjunct in keeping people healthy and out of hospital in areas across our footprint with limited or no access to after hours primary care. In the 2011/2012 financial year, the after hours GP Helpline received more than 5000 calls from our region. While more than a third of callers had intended to go to their hospital’s Emergency Department, more than half of these callers were offered reassuring self-care advice and

advised to see their regular GP the following day. North Coast Medicare Local has been promoting the GP helpline through TV and radio ads and bus signage to increase awareness of this important service throughout the North Coast. We have also produced a testimonial video which can be viewed on the Healthy

North Coast website (www. healthynorthcoast.org.au) featuring Lennox Head GP, Dr Ann Staughton, who works as one of the GPs on the after hours Helpline. Ann told HealthSpeak that when she first told her colleagues she was working on the GP helpline they thought she was mad. “They said to me: ‘What do you want to be doing that for? But for me it’s important to keep up with digital technology and video consultations and this was one way to do that. “The after hours GP helpline is cutting edge and in the US GP video consultations are commonplace and you get paid for them. “ It is different to seeing a

patient in front of you, but a lot can be done through telehealth. It’s fast and easier to access and makes sense,” said Ann. The after hours GP helpline is expected continue to reassure patients who have minor, non-urgent health concerns so as to relieve considerable pressure of Emergency Departments and reduce the pressure on GPs during the after hours period, improving their overall worklife balance. North Coast NSW Medicare Local will soon be promoting the use of this service in more regional and remote villages and communities that have no access to after hours primary health care. The after hours GP helpline number is 1800 022 222.

Are you aware of our Public Dental Services? A range of oral health services is provided through the NSW public health system and includes dental services to children and adults. To make an appointment or to speak to staff at one of the dental clinics, on the NSW North Coast, call the Oral Health Customer Service Line on 1300 651 625. The service is available to all children under 18 and to eligible adults.

Adults must: Be normally resident within the boundary of the providing Local Health District, and; Be eligible for Medicare, and; Be 18 years of age or older, and; Hold, or be listed as a dependent on a valid concession card: – Health Care Card

– Pensioner Concession Card – Commonwealth Seniors Health Card. Services are available across the North Coast from Port Macquarie to Tweed Heads at Ballina, Casino, Coffs Harbour, Goonellabah, Grafton, Kempsey, Laurieton, Maclean, Mullumbimby, Murwillumbah, Nimbin, Port Macquarie, Tweed Heads and Wauchope, Pottsville.

Southern Cross University Clinic requires motivated and forward thinking VR’d GP Lismore New South Wales FT/PT GP required for University Clinic. The University Clinic provides health services to the student cohort, staff and general public of the Northern Rivers Region. This is a purpose built facility which also provides Allied Health Practitioners, Student Practitioners, Research and promotional activities to the University community and general public. The clinic works collaboratively with external partners in the area. Please phone Clinic Manager on 02 66 203 890, fax interest 02 66 269 135, or email marlene.assim@scu.edu.au. All enquires will be treated as strictly confidential http://www.scu.edu.au/healthclinic/

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Carnival atmosphere at Healthy North Coast Launch The official launch of North Coast Medicare Local’s new Healthy North Coast – an online hub for everything to do with health – was a fun event with special appearances from a range of health promotion characters and kids from The Spaghetti Circus staging a breathtaking performance of skill and flexibility. Healthy North Coast belongs to the whole community and is not just a website, it’s a complete social and information networking arrangement – a means for collaboration, for sharing, for informing, for linking and for change. At the launch on May 8, NCML’s CEO Vahid Saberi thanked the many people had contributed to the concept and establishment of Healthy North Coast and he described the launch in May as a process, not an event.

A performance from the Spaghetti Circus kids was a launch highlight.

“This is really only just the beginning. Healthy North Coast will grow with input from the community and other organisations. It will be an organic process with no end.” NCML’s Chair, Dr Tony Lembke, led the countdown to the official launch with the

enthusiastic assistance of the Spaghetti Circus kids and all those present. “I’m a GP and we know that for 50% of our patients now, we are providing a second opinion for Dr Google and it’s fantastic that people have access to information to help them man-

age their health better. We want to make sure the information they can access is reliable and authoritative, and most importantly, local. “Part of our mission as a Medicare Local is to help keep people well and out of hospital and part of that is giving them the information, the resources and the skills and importantly, the teams they need to look after their health and the health of their families,” said Tony. Check out Healthy North Coast at: www.healthynorthcoast.org.au

Making it happen HealthSpeak spoke to the NCML staff member behind the building of Healthy North Coast, Social Media Coordinator, Alex Lewers. H: Tell us a bit about your background A: Before starting with NCML, I completed my Bachelor of Media with Honours at SCU. During that time I worked as a volunteer media officer in Federal MP Janelle Saffin’s office and then moved to The Northern Star. I took on this role in January, just four months ago. H: How did the concept evolve? A: We started out thinking that we would let the content drive the website, so we picked key areas and key groups – Indigenous people, seniors, teenagers etc. And then we let it evolve organically. We looked at a few health websites to see what they were doing well and not so well, and we’ve worked

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to make Healthy North Coast the best site we could. H: What’s your role now? A: I’ll coordinate the Twitter, Facebook, Google+ and YouTube components of Healthy North Coast, and continue to build the website. But the main idea of the social media platforms, while they are quick to get information out, they are really to drive traffic towards the main website. H: What’s your approach now the website is up and running? A: We’re still developing links to organisations and now that we’ve launched, that is a big part of my role. Working with organisations to get them on board, to give us a hand and take some ownership of the website. It’s a community collaboration and It’s not just us doing the work anymore. H: Who would you like to help build the hub? A: Anyone and everyone who’s interested, particularly

Alex Lewers is waiting to hear about your ideas for the website.

health practitioners, we’d love to see them join us. Not just GPs, but health professionals from all modalities. We look forward to working with other groups to build the information and resources on HNC. H: How can organisations and practitioners showcase what they’re doing? A: We’re running video and podcasts, as well as news and events. If people want to con-

tact us with an event or an activity that’s running anywhere between the Queensland border down to just south of Port Macquarie, we’ll put it up for them. On each page there’s a resource section and if people suggest a good resource, we’ll add it. And if people think there’s a particular issue not represented on HNC, then

Continued page 10

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Moving Life Stories project PITCHed at Tweed Heads Dr Sharon Dean and Greg Price from Maranoa Centre Alstonville received the ‘most outstanding’ award at the third PITCH (Practical Ideas to Change Healthcare) event hosted in Tweed Heads in May. Dr Dean’s moving PITCH video featured examples of the Interactive Life Stories project and her idea of supporting other Residential Aged Care Facilities across the North Coast region to implement a similar initiative through a mix of training and development of standardised resources. The project involves creating storyboards about the lives of their residents which are posted in the foyer. This creates connection, engagement and a deeper appreciation of aged care residents. You can view the video about the project at: http://www.youtube.com/ watch?v=-Gomma42K94 The PITCH is part of North Coast NSW Medicare Local’s ongoing effort to tap into local innovative ideas for better health across our region. Earlier

ing the event. North Coast NSW Medicare Local will now work with Maranoa Centre at Alstonville to support their idea become a reality, while Dr Dean will have up to $3,000 to spend on a continuing professional development venture of her choice as part of the award. Other PITCH finalists included:

From left: Greg Price, Dr Sharon Dean, judging panel members Sandie Downsborough, Carol Bell and Dr Di Blankensee; and Acting General Manager North Coast NSW Medicare Local, Tweed Valley Office, Wendy Pannach.

this year, local Residential Aged Care Facilities, health workers and community members were invited to submit a PITCH on the theme of ‘Improving the health and quality of life for people living in Residential Aged Care Facilities’. Of the submissions, four finalists were

shortlisted and asked to present at the awards night. All of the PITCH finalists proved popular with an appreciative audience of about 30 people, including Residential Aged Care workers, General Practitioners, Nurses and other Allied Health specialists attend-

Sarah Marciano from Feros Care at Bangalow – Up-skilling Registered Nurses working in Residential Aged Care Facilities Jade Sinclair from Bundaleer Care Services – Fishing program for male Residential Aged Care Facility residents Mary Griffin from The Whiddon Group Grafton – Client First philosophy

Craft space for carers PITCHed at Coffs Harbour Ruth Weston from Carers NSW was awarded the ‘most outstanding’ award at the second PITCH (Practical Ideas to Change Healthcare) event hosted in Coffs Harbour in April. Ms Weston’s PITCH to establish a craft meeting space for carers was judged to be the most outstanding, while Jodie Johnson from Greenway Cottage Counselling was highly commended for her parents and children’s emotional literacy program PITCH. The PITCH is part of North Coast NSW Medicare Local’s ongoing effort to tap into local ideas for better health across our region. Earlier this year, local health workers and community members were invited to submit a PITCH on the theme of ‘Promoting Good Health on the North Coast’. Of the submissions, six finalists were shortlisted and asked to present at the 6

Overjoyed, Ruth commented that her PITCH award was ‘Better than winning the lottery!’ Other PITCH finalists included:

From left: Dr Ian Arthur, Ruth Weston, Karen Plumbe, Karina Morrison, Jodie Johnson. Apology from Dr Andrew Black.

awards night. All of the PITCH finalists proved popular with an appreciative audience of more than 30 people, including general practitioners, nurses, pharmacists and other allied health specialists attending the event.

NCNSWML will now work with all PITCH finalists and support their ideas become a reality, while Ruth will have up to $3,000 to spend on a continuing professional development venture of her choice as part of the award.

Dr Ian Arthur of Toormina Medical Centre – Practice Nurse Scholarships Karen Plumbe of KJP Coaching and Training – ENERGIZE Healthy Lifestyle Coaching Dr Andrew Black from Bulgarr Ngaru Medical Aboriginal Corporation – Walking and Traditional Indigenous Food Gathering program Karina Morrison from Australian Hearing – Quit Binge Listening: Noise harm minimisation program for young people

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Advertorial

“When would my patient benefit from admission to a private psychiatric facility”? This is one of the most common questions asked by General Practitioners who are managing patients suffering from a broad spectrum of mental health issues. Typically, patients who are referred into Currumbin Clinic are those suffering from depression, anxiety and substance abuse problems. These are the high prevalence disorders that present most commonly in the community and cause the greatest morbidity. Although these patients can be managed in the community, there is great benefit in early intervention and engagement with highly trained specialists in mental health care. At all stages in life mental health wellbeing is affected by the quality of relationships,

the capacity to work and to function within family and social environment. Triggers such as a breakdown in a relationship or loss of income / work can cause some patients to seek help and these patients commonly do very well from a brief admission into Currumbin Clinic. The focus of treatment at Currumbin Clinic is on accurate diagnosis and recovery to optimum function. Currumbin Clinic provides a range of in patient, day patient and out patient services; treatments include psychological therapy (CBT & Mindfulness), medication therapy & assistance in dealing with life circumstances. For those patients experiencing issues with addictions, Currumbin Clinic offers both

in patient and day patient treatment options focused on this specialised area. For the older population, depression, anxiety and declining memory are common reasons why these patients present for treatment; the symptoms can be associated with altered physical health and responses to significant life changes associated with ageing. Several treatment options exist for those patients not requiring in patient admission. One option is a referral to an accredited Psychiatrist for an expert opinion, (item 291) includes development of a management plan, then the patient is referred back to the GP for ongoing treatment. These ‘once off ’ referrals can be used to confirm

a diagnosis or for a medication review. If ongoing psychiatric care is required this can continue with the Psychiatrist. We offer a further alternative to in patient care in the form of day programs, these include: mood & anxiety, specific older persons’ programs, drug and alcohol and post traumatic stress disorder programs (military and emergency service personnel). These programs are offered on a variety of days and evenings. As a private facility, private health insurance is highly recommended. For further information regarding Currumbin Clinic or any of our services please contact Currumbin Clinic assessment team on: (07) 5534 4944 or fax (07) 5534 7752.

Depression, Anxiety and other Mental Health issues do not discriminate. Currumbin Clinic is a private hospital specialising in treating a wide range of mental health issues including anxiety, depression, alcohol and other drug related problems. Don’t sit in silence, call Currumbin Clinic today to discuss how we can support you.

07 55 344 944 www.currumbinclinic.com.au 37 Bilinga Street, Currumbin *General Practitioner referral necessary ** Private health insurance & self funded referrals accepted. Call our staff for more information.

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Broad agenda at joint May Board Meeting

Front then left: Leonie Craydon, Lesley Barclay, Deborah Monaghan, Rosie Kew, Dan Ewald, Malcolm Marshall, Tim Francis, Chris Crawford, Brian Pezzutti, Tony Lembke, Philip Silver, Scott Monaghan, Hazel Bridgett, David Frazer, Allan Tyson, Vahid Saberi.

The NNSWLHD and NCML joint Board meeting was held on 29 May at the University Centre for Rural Health in Lismore. A broad and varied set of matters was discussed including - Joint Vision for Health: Partnership for Health System Reform and Improvement - Health Pathways Program - Colocation of LHD Community and Allied Health Services with General Practice - Alliance to Improve Provi-

sion of Services to the Vulnerable Members of the Community: the homeless; people with a disability; and children at risk of significant harm - Joint Projects: Bonalbo GP recruitment; Palliative Care Registrars; Chronic Disease Management (Connecting Care); Social Media (Healthy North Coast); Gurgun Aboriginal Medical Service. The next joint Board meeting will be on 4 September.

New MNC Health Promotion Network NCML hosted a Mid North Coast Health Promotion Workshop at Kempsey RSL in May, led by CEO, Vahid Saberi. The workshop was the first for the region and there are plans to run similar ones in other places. This event brought together key agencies involved in health promotion to start discussing possible activities and where they could collaborate. A total of 26 people attended, included representatives from MNCLHD, Aboriginal Medical Services, local councils and NGOs. The workshop built on NCML's work in addressing health promotion, where the organisation contracted a health promotion project officer to map existing health promotion activities across the North Coast. Six categories of health promotion were identified: 1. Nutrition, Physical Activity 2. Tobacco Control & Tobacco Cessation 3. Falls prevention & Injury Prevention

4. Alcohol Abuse Prevention 5. Mental Health/Emotional Wellbeing 6. Setting/Population Specific Programs There was much discussion around the use of social media to reach young people and suggestions were made as how service providers could effectively use the Healthy North Coast Website to reach people. From the workshop, there emerged a draft proposal for setting up a Mid North Coast Health Promotion Network and NCML will convene the first Health Promotion Network meeting shortly.

Warm welcome for the Telehealth Roadshow

Catch up with HealthSpeak online Did you know that more than 14,000 people read the last issue of HealthSpeak online? It’s also an ideal way to catch up on previous issues. And you might like to let colleagues know about HealthSpeak online. Go to: www.issuu.com/ healthspeak

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North Coast Medicare Local (NCML) staff on the Telehealth Roadshow came face to face with nearly 150 health professionals from the Tweed down to Port Macquarie over the course of four weeks recently. Overwhelmingly, those who took part said the presentation on Telehealth was useful and informative and they appreciated the opportunity to ask numerous questions. Members of NCML’s EHealth and Practice Support teams worked together to present the information sessions about Telehealth to staff at general practices, residential

aged care facilities, specialist clinics and Aboriginal Medical Services. Roadshow coordinator, Shelly Fletcher said the mobile presentation covered a range of topics Definitions and background information Benefits for providers, organisations and patients Financial incentives and eligibility Logistics Consent, privacy and delivery Performance, commissioning of

equipment and risk management Many of the professionals who attended presentations said they would be more likely to participate in Telehealth consultations if there was designated equipment and a room set up for this reason. There were also numerous requests for more information about the practicalities of conducting a Telehealth consultation and a demonstration and NCML is looking at how to accommodate these. For more information on Telehealth, contact Shelly on 6618 5400.

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Do you need eHealth registration support? North Coast Medicare Local (NCML) is conducting a trial to support health organisations to increase consumer registration for the personally controlled electronic health record (eHealth). The Assisted Registration Tool (ART) used in the trial allows clinic staff to more easily verify a consumer’s identity, which previously proved problematic. Using this method, last month NCML staff Shelly Fletcher and Simone Currey signed up 30 patients ranging from babies to seniors, in just two hours at Greenmeadows Medical Centre in Port Macquarie . They also promoted ART to other patients interested in the eHealth record and staff at the medical centre were given an introductory talk on the new registration tool. It was also pleasing to sign up 12 consumers who visited the NCML stand at the Innovation Awards Expo in Coffs Harbour in May. In order to be ready to obtain the ART software package and take part in the trial, a health organisation must: Have received a HPI-O Installed an organisation PKI Installed an eHealth PKI (Nash PKI) Be registered in the eHealth record

Have signed the Participation Agreement

From left: NCML’s Simone Currey, CEO Vahid Saberi and Shelly Fletcher at Greenmeadows Medical Centre after signing up 30 patients to set up their ehealth record.

A useful website to help is: Http://www.ehealth.gov.au/ internet/ehealth/publishing. nsf/content/assistedreg_01 If you take part in the ART trial, NCML staff will help you to register, supply draft policies, invite you to attend training sessions, support you to implement ART and share in lessons learned. In collaboration with the Royal Australian College of General Practitioners, North Coast Medicare Local has also held a number of eHealth information nights which have proved popular. Nearly 200 health care workers attended these events. To find out more about eHealth support, phone Shelly Fletcher on 6618 5418.

From left: NCML’s Casey Guthrie; Associate Professor Kate Swanton, Manager Allied Health and Wellness at Feros Care; and NCML’s Lisa Hampson after a morning tea at Feros Care in Byron Bay to inform Feros staff about the importance of signing up residents to the eHealth record.

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Pottsville HealthOne opens When HealthSpeak visited the new Pottsville HealthOne Clinic, Dr Julian Chin and his fellow GPs and staff had been in the building since the 8 April 2013. A community health dental clinic had also opened. The $3.7 million HealthOne is state government funded and was opened by Health Minister Jillian Skinner and Tweed MP Geoff Provest in April. A variety of community health services are proposed for the clinic including physiotherapy, occupational therapy, speech pathology, social work, indigenous care, dietetics, and child and family health. Dr Julian Chin said he and his staff were delighted with their new workplace and were looking forward to working together with the other health professionals when they arrived. Julian explained the Pottsville HealthOne model. “HealthOne Pottsville will integrate community health and general practice services, child health and related health promotion and prevention activities, allied health services, aged care and community services. This coordinated and integrated approach to service delivery, in addition to the development of strong partnerships with community stakeholders, will support and promote wellness within the community.” “It’s a slightly different model of healthcare delivery to a Super

Pottsville HealthOne staff – from left rear: Jeanette Buchnan, Roslyn Philp. Front: Dr Zekri Palushi, Dr Julian Chin, Lorraine Keevers, Dr Ramana Panda

HealthOne brings varous health services under one roof.

Clinic. HealthOne does not have pharmacy, radiology nor pathology on site and does not operate for extended hours .” “And the physio and allied health presence is through community health access. There’s a dentist down the corridor. They’ve started and they are car-

ing for children in the catchment area, any pensioners, health care holders, senior citizens can access their dental services, which is excellent.” Julian was approached around 10 years ago to see if he’d be open to integrating his Pottsville General Practice with communi-

Living with dementia: identification, management and service pathways North Coast NSW Medicare Local and Alzheimer’s Australia NSW hosted the Identification, management and service pathways for people living with dementia workshop at Mantra on Salt Beach, Kingscliff on 18 April. Over 70 GPs, nurses, practice staff and service providers from the private, community and government health sectors attended the workshop. It included professional development on identifying dementia, introduced practitioners to service providers offering support for people living with dementia, 10

and showcased new resources designed to improve access to timely diagnosis of dementia and streamline referral pathways. Dr Lana Kossoff, Aged Care and Forensic Psychiatrist, presented on the 4Ds (dementia, delirium, depression and drugs), as well as medication issues in the elderly – Dr Kossoff presented case studies illustrating substantially improved outcomes for elderly patients and their families with accurate diagnosis that differentiates the 4Ds and provides appropriate treatment. The program also included a

tour of the Alzheimer’s Australia Detect Early website, a demonstration of the North Coast Area Health Service’s new Telehealth Link environment facilitating greater access to specialists in the North Coast area, and the launch of the Dementia Services GP Flipchart and the referral pathway. For more information about dementia resources, information and support contact reception at the North Coast NSW Medicare Local Tweed Valley Branch on 02 6672 5158 or Alzheimer’s Australia NSW on 1800 100 500.

ty health in a HealthOne Clinic. “It was slightly coercion, I couldn’t really say no and deny Pottsvillians their community health building, “ he smiled. I have no regrets now that I have worked in HealthOne. But he explained that his general practice had outgrown its infrastructure which was just two shop fronts in a shopping arcade. “We needed new physical premises anyway. And population demands were getting too excessive, but we didn’t have the room to expand to a fourth doctor and we can now. It’s been good for us,” Julian told HealthSpeak. All of the practice staff moved across and options are there to expand the admin team when the fourth doctor arrives. “We have a very willing and able team,” said Julian. Recruiting a fourth doctor has been difficult. Despite advertising it is likely that the position will be taken by an international medical graduate doctor working in an Area of Need Position. What the Practice needs is a female GP.

From page 5 we’ll endeavour to get it up as soon as possible. They can contact me by going to www. healthynorthcoast.org.au, follow the link to Contact Us and email me. H: How are the directories going? A: Directory entries are welcome. We have a number of directories we are building – sexual health, mental health, Aboriginal health and others that people suggest. Eventually, we will have the National Health Services Directory embedded within the website, so people can search for their nearest GP or pharmacy easily. The main message I want to get out is the importance of collaboration and building partnerships with people in the community.

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UCRH submission supports medical cannabis A senior lecturer from the University Centre for Rural Health (UCRH) North Coast submitted a letter of support for legalising marijuana for medical use in NSW to a Legislative Council Standing Committee Inquiry which unanimously recommended the medical use of cannabis for people with terminal illness and AIDS. If adopted by the government, the measure will allow patients to use up to 15 grams of dry cannabis or its equivalent in cannabis products. Dr Hudson Birden, Senior Lecturer, Population Health and Epidemiology at UCRH, and a member of the Australian Drug Law Reform Foundation, told HealthSpeak that while it was the first time he’d penned such a letter of support, he has a strong

interest in the topic. “It’s an area that I’ve been interested in for a long time and I follow everything that comes out. Especially in the US there are so many people in prisons for possession of drugs. This should be a health issue, not a law enforcement issue. “Coming from a public health perspective, the harm we can avoid and the good that we can do includes not demonising people for the use of drugs and treating drug use in another way,” he said. Hudson said that when recreational cannabis use was instituted in the US, the political agenda was to exercise social control against marginalised groups – African Americans and Mexican Americans. “In the early part of the 20th

GenHealth Inc.: your partner in preventative health and early intervention With lifestyle habits implicated in most chronic disease, a range of low or no-cost programs encouraging personal involvement in health, support health professionals achieve best practice. GenHealth Inc., trading as the Coffs Harbour Women’s Health Centre, has become a valuable resource for health professionals managing the complexities of patients’ chronic conditions and those looking for support in improving their personal health and wellbeing. The friendly and supportive group environment offered by the Centre provides a welcoming venue for the gentle movement classes, women’s circles, personal development and parenting workshops, and health awareness courses. Health professionals have reported excellent feedback from Energize, a healthy lifestyle program covering motivation, nutrition, exercise, relaxation, goal-setting, self-belief and sleep. Although based at Coffs

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Harbour, the GenHealth team, in partnership with MNCLHD, offers courses at various centres, with Go4Fun and Stepping On being run in centres from Lismore in the north to Port Macquarie in the south. Go4Fun is a free program empowering kids 7-13 years who are over a healthy weight and their families to become fitter, healthier and happier. Stepping On is another free group program which improves strength and balance, increasing awareness of the dangers of falls, providing information on nutrition, stronger bones and medication, and fostering social connection and independence. It’s available to men and women over 65 years living independently at home. Individuals can refer themselves or health professionals can make referrals. For more details or to be sent referral forms, call Karen Plumbe on 6652 8111 or email kplumbe@chwhc.com. au.

Dr Hudson Birden

century those groups were perceived as the people that used cannabis, so outlawing cannabis became a means of social control, exercised wrongly. I’d like to see that historical wrong addressed.” In his submission he summarised the evidence regarding medicinal uses of cannabis including only human studies. “There is compelling evidence that cannabis has therapeutic benefit in treating many diseases. Specifically…in the treatment of multiple sclerosis, chronic pain, glaucoma, mental illness, depression, bipolar disorder, alleviating adverse side effects of chemotherapy and increasing appetite in people with cancer and HIV/AIDS, and may have effectiveness in Huntington’s disease. Cannabinoids contain potent anti-tumour agents, thus cannabis smoking may prevent cancer. “ The submission went on to say

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that there was little evidence of potential harm in the medicinal use of cannabis. “Smoking cannabis does not appear to have the same degree of impairmentof lung function as tobacco smoking does. The ‘pathway’ theory, which posited that cannabis use leads to ‘use of harder’ drugs, has been discredited and disproven. Cannabis is non-addictive, although there is evidence that users can develop a psychological dependence leading to social dysfunction.” Hudson also stated that “the evidence regarding cannabis and psychosis or schizophrenia is not clear. While there is evidence that cannabis can cause deterioration in a person already prone to psychosis, cannabis also appears to have a role in treating schizophrenia.” The submission to the inquiry also stated that the use of cananbis should be discouraged in adolescents as heavy use can interfere with brain development, as does alcohol, and may lead to a higher risk of depression in later life. Hudson also brought the success of medicinal cannabis programs in the US to the attention of the inquiry. “US states permitting medical cannabis have experienced a 90% decrease in suicide rates and an increase in overall (non-medical) but not adolescent cannabis use

Continued page 29 What would you do for

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Launch of aged care in emergency (ace) Aged Care in Emergency (ACE) is a new Model of care being implemented in the Lismore Base Hospital Emergency Department and is financed by the NSW Ministry of Health. It has successfully been implemented in the John Hunter Hospital in Newcastle and is now being rolled out in 10 hospitals. The local launch of ACE took place at Lismore Base Hospital, in collaboration with North Coast Medicare Local in March. The CEO of GP NSW, Lewis Kaplan, accompanied NCML’s CEO Vahid Saberi to the launch while on a visit to North Coast Medicare Local’s head office in Ballina. ACE aims to improve the management of residents from Residential Aged Care Facilities (RACFs) when they become acutely unwell, by providing support and care in their own residence, and efficient flow through the Emergency Department (ED) if required. It is built on a collaborative relationship between the management and staff at RACFs, the resident’s GP, the ED and the hospital. It incorporates: A telephone consultation between the ACE Nurse and staff from RACFs Guidelines for common problems that will

From left: Chris Gavaghan (Director of Emergency), Kathleen Shaw (ACE CNC), Christine Reeves (Residential Manager, BCS Maranoa Centre Lismore), Isla Attewell (ACE CNC), Vahid Saberi, Mary Lou McFadzean (NUM Emergency LBH), Kylie Connelly (Care Manager, Caroona Jarman Hostel, United Care Ageing)

provide support for RACF staff to manage the resident at home Medical support by Aged Care and Emergency specialists Proactive case management in the Emergency Department ACE has been launched in the four RACFs within the 2480 postcode by two Clinical Nurse Consultants, Isla Attewell and Kathleen Shaw. The following example shows the benefits for patients referred to ACE. An elderly gentleman with advanced Alzheimer’s disease

had a fall in the RACF sustaining a head injury and required transfer to the ED for suturing. The RACF staff followed the flow chart for fall with head injury in the manual, called the GP and ACE, giving a full handover of the patient’s history and behaviour management plan and alerted the Department of his impending arrival. After assessment and investigations were complete, the family requested that their father be looked after in the RACF in a familiar environment with staff who understood his needs. ACE was able to arrange with the GP and RACF an

appropriate ongoing care plan in the RACF. The patient was discharged with a medication chart for pain relief and medication, a head injury advice sheet and staple remover to allow the RACF staff to remove his staples. An ambulance was booked, however hospital transport with an escort was available, and the patient was transferred back to the RACF within 20 minutes. A copy of the discharge letter was sent to the GP and RACF, and a follow up call to the RACF to check on the progress of the patient was made the following day. The involvement of ACE improved the patient’s journey through the ED and communication between the RACF, GP and ED. The use of hospital transport allowed the ambulance service to attend more urgent cases. ACE gives a point of contact in the acute care setting for the RACFs staff and GPs and it gives ED staff access to accurate information in a timely fashion to make care related decisions. ACE is also involved in providing education to all RACF staff to increase confidence in using the manual , and education is being offered using a simulator with various scenarios covered. For more information, contact Kathleen Shaw or Isla Attewell on 6620 7442 or email: LismoreACEProgramme@ ncahs.health.nsw.gov.au

Males get eating disorders too The National Eating Disorders Collaboration has issued a fact sheet on eating disorders in males. It states that eating disorders are serious mental illnesses. “While they are often portrayed as disorders that only affect females, one in ten people diagnosed with an eating disorder are male. “However, we also know that the under-diagnosis and the cultural stigma boys and men face means that the actual proportion of males with eat-

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ing disorders could be much higher,” the fact sheet states. Dr Susan Joyce conducts eating disorders assessments at Lismore’s Community Mental Health service. On a patient’s second visit Susan takes down a detailed history which can take a couple of hours. This is then used as the basis for treatment by the professional the patient is referred to. Susan said it’s interesting that a patient can come back 10 years on and their history is still relevant to what is happening

to them – the disorder doesn’t really change as it’s based on early perceptions of self and the patient’s background. She told HealthSpeak that recent research indicated that the prevalence of eating disorders in males was estimated to be similar to that in females, although fewer men presented with an eating disorder.

NNSW Eating Disorder Service is funded by NSW Health and is based at Lismore Community Mental Health - (02)6620 2300.  This is an eating disorders assessment and referral service coordinated by Susan Joyce Susan. Joyce@ncahs.health. nsw.gov.au.  Those with eating issues or caring for someone with eating issues can ring the Mental Health Line 1800 011 511.

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Dealing with the vaccination debate The University Centre for Rural Health hosted immunisation expert Assoc Prof Julie Leask from the University of Sydney for a guest lecture in April. Julie’s talk followed the release of the National Health Performance Authority’s report on immunisation rates in Australia. She described the report’s media coverage as ‘some breathless commentary and sensational headlines in which I was selectively quoted’. Speaking to a full lecture theatre, Julie said the media mentioned that the NSW North Coast had the lowest immunisation rates (89%) in the country for kids aged two, the most sensitive indicator for immunisation rates. She said the media coverage prompted a lot of discussion about the antivaccination lobby and parents who won’t immunise. “Opposition to vaccination is as old as the practice…it’s been around since Jenner developed the smallpox vaccine 200 years ago and it’s with us today, it’s not new and it’s not going to go away,” Julie told her audience. She said parents were wondering why there are increasing diagnoses of autism. “And so you have this causal hunger – and this is what drives people who are very critical of vaccination to list all of these things as possibly being caused by vaccinations. “And what you notice about these conditions is that they have an idiopathic origin.”

Julie explained that it was intuitively appealing to link vaccines to these things despite the lack of evidence for a causal link. She then put Australia’s immunisation rates into perspective. “Despite what you read, our national immunisation rates for kids under five are pretty high and stable, although we could do better. “At the moment, 93% of three years olds are fully vaccinated. Rates are not declining despite what we see in the media,” said Julie. She said research showed parents who didn’t fully immunise their kids broadly fell into one of two groups. The first group (58%, ‘worried about vaccines’) either disagreed with vaccination or had concerns – side effects, immunisation seen as not effective, preferred natural approaches or felt vaccinations contained toxic substances. The second group (the logistics group) had other reasons for delaying vaccination – doctor’s advice, family breakdown, competing priorities and forgetfulness. Julie said the ‘worried about vaccines’ group were more likely to be tertiary educated, very conscientious about everything they do, wanting to research things and not go with the flow, and often practising alternative lifestyles. “We know from national surveys about one-fifth to onequarter of parents have concerns

one-fifth fo one quarter of parents have vaccination concerns. For hesitant vaccinators, Julie suggests health professionals walk with them in their dec ision process and respect their autonomy. Some helpful measures:

Assoc Prof Julie Leask

about vaccination.” To address these concerns, Julie and colleagues are working on a framework for health professionals to communicate efficiently and deffectively with parents about immunisation. In order to get parents to move towards immunisation a tailored approach is being developed to address different positions: Unquestioning vaccinators Hesitant parents with significant concerns The group who select or delay certain vaccinations Refusal group who won’t vaccinate

Avoid the ‘rush in’ and correct reflex when something wrong is said. Better to explore concerns and where they come from. Asking permission to discuss the issue is more likely to bring success Communicate risk well – define what the risks are. Some people think ‘rare’ means 1 in 10 when it means 1 in 100,000. Use ‘chunking and checking’ – delivering small pieces of information and checking for understanding Book another appointment if things are taking too long and use good quality information For some useful resources go to: http://www.ncirs.edu.au/

Communication - Expression - Self Care - Active Listening Essential skills for all health care professionals for a successful, sustainable health care practice Develop Your Natural Voice with voice and mind/body awareness educator Chris James Education Centre, St Vincents Hospital, Lismore. Saturday 23rd November 2013 Professional development course for GPs, practice staff & all health care professionals 9am - 5pm Cost: $120 Lunch and light refreshments included. Designed to promote skills in clear communication, vocal tone and confident self expression, recognising stress, self-care, presence – all vital in client consultation and for a cohesive work environment in the medical practice. Chris James’ acclaimed expertise provides an invaluable interactive experience. Approved by RACGP QI&CPD program Activity no. 761 125 Total 40 Category 1 points Contact: Jenny: Ph 6628 3308 E: admin@chrisjames.net www.chrisjames.net

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Mothers and babies thriving at Mothers Group First time mothers generally find the period when they leave hospital after giving birth and head home with their newborn the most challenging for themselves and their partners. Jane Sipe of Goonellabah puts it this way: “I had a really great experience at the hospital but once I left and the doors closed I didn’t know after that where you go to for help. Fortunately, the child nurse in Goonellabah recommended that I come to the Northern Rivers Family Care Centre. ‘It’s really, really good’, she said and now I have tremendous support and access to expert advice.” The Northern Rivers Family Care Centre is run by North Coast Medicare Local and last year celebrated its 10th anniversary. Jane’s daughter Ujjwala is now eight months old and their first contact with the Family Care Centre was during a day stay when Ujjwala was just 10 weeks. “The first person we saw here was [Child and Family Health Nurse} Anne Prideaux and that

Jane Sipe of Goonellabah with a relaxed baby daughter Ujjwala.

first visit resulted in a dramatic change in how I was looking after Ujji. I didn’t know babies could handle being left in a room and I had her in a high traffic area in the house where I could see her and she wasn’t sleeping, she wasn’t getting much rest. We checked in for a day stay and it went really well,” said Jane with a smile. Jane and Ujjwala have hardly missed a Mothers Group since Ujjwala was eight weeks old and she is not looking forward to

the time when she and her baby leave the group at 12 months. However she’s hoping that an informal Mothers Group grows out of this one. Casino first-time mum Karina Townsend really appreciates the support and social opportunities that the weekly Mothers Group gives her and baby Ella, now 10 months. Karina told HealthSpeak that she found it difficult having no friends with babies and often felt a bit isolated.

“We travel from Casino each week, Ella was born in Lismore Base and it’s a nice outing for us to come here and good to socialise with other babies and mummies,” she said. “You don’t feel as alone when you go from here. You know that other mothers are doing exactly the same thing every day as you and you don’t feel as isolated. It’s a lovely group and becoming a parent really changes your life.” Like Jane, Karina has also made use of the Family Care Centre’s day stay program. “Ella wasn’t sleeping, she wouldn’t go to bed of a night in her cot and we were struggling big time with that. [Child and Family Health Nurse] Mary Wickham helped us a lot and it’s been 100 times better than what it was before. I was only getting about four hours sleep a night and it got to the point where I needed help. I wasn’t coping very well,” Karina explained. “Things are much better, but there’s still a way to go.” Northern Rivers Family Care Centre – 6622 8705.

GP placements needed for nursing students Southern Cross University is looking for general practices interested in engaging a nursing student for work experience placements of two, four or six-week periods. Lissa Ingram, clinical teacher leader in the School of Health and Human Sciences at SCU said there was a lot of student interest in spending time in a general practice setting. She said students who’d done work placements had gained positions upon graduating with Tintenbar Medical Centre, Bangalow Medical Centre and Meridian Health Care in Goonellabah. One student who did a work placement at Bangalow Medical Centre is now working in a graduate position at Royal Prince Alfred Hospital in Sydney. Twenty-one year old Bridget

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Barnes is hoping similar primary care placement opportunities will be a springboard for other undergraduate nurses. “I learnt so much. I worked one-on-one with a RN and very closely with the doctors,” Bridget said. The University is encouraging GP clinics across the North Coast (from Tweed Heads to Taree) and the Gold Coast to consider taking on a nursing student to broaden the clinical work placements on offer. “The GP clinic is a valuable training ground,” said Ms Ingram. “Our student nurses get lots of one-on-one attention from the supervising nurse. As well, they get to practise a range of skills, in particular communication skills because of the need to establish a relationship with the patient within 10 minutes.”

Bridget Barnes with medical student Lernik Sarkissian at Bangalow Medical Centre.

Bridget said her work placement was practical and hands-on. “I liked being the primary care giver to the patients. I became confident with subcutaneous and intramuscular injections, performing and interpreting electrocardiograms, wound dressings and

venepunctures. I was applying and removing plaster casts, triaging, developing care plans, referring to allied health practitioners, performing sterile procedures, chronic health care assessments.” Bangalow Medical Centre’s registered nurse Rhonda West said the mentoring experience was worthwhile. “I like being able to share with the students my knowledge and enthusiasm for general practice. They are keen to learn within a supportive environment.” “Bridget had great interpersonal skills and was able to apply those and was very well accepted by the patients and staff,” said Rhonda. If you are a GP clinic interested in engaging a nursing student, ph Lissa on 0447 624 472 or Anna on 0458 761 427.

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What to do when the going gets tough in Aboriginal Health? Skate! By Amanda Shoebridge North Coast GP Training Working to reduce health inequalities is strongly embedded in the culture of medical professionals, and is often the primary motivation for medical practitioners working in the field of Aboriginal Health. However, this field holds many challenges for doctors as they strive to help their patients overcome enormous obstacles in the face of great health inequality. The phrase work life balance is frequently bandied around, but I often wonder how many people get this magic balance right. Recently, I met a group of young medical professionals working at Bullinah Aboriginal Health Service in Ballina. These guys have cottoned onto a great idea to help achieve this illusive balance and they have found it has become a positive coping strategy for them. Their strategy is simple, yet effective. It helps them to debrief, to talk about their challenges, to build strong relationships within their team and they say it enables them to be better practitioners. Their strategy is skateboarding. In fact, the strategy can be anything. Surfing, walking, riding, skating – anything. Although skating and surfing are the activities of choice for this group, which includes Dr Frank Schultheiss, a GP Registrar with North Coast GP Training; Ben Hill, a Canadian medical student who will apply for NCGPT next year; and Liam Byrne, a registered nurse. Following is an edited interview I did with Frank, Ben and Liam about their Men’s Health Group. What is it that draws you to work in Aboriginal health? “I’ve always had an interest in Aboriginal welfare. I was born out in Western NSW, so a lot of my friends in primary school were Aboriginal and I could see the need for increased services in their communities. So I guess HealthSpeak

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Liam

Ben Liam Byrne, Ben Hill and Doctor Frank Schultheiss love their leisure.

my interest dates back to childhood”, said Liam. “Working at Bullinah is a great way to broaden my horizons and to learn about Aboriginal culture from patients and colleagues. At this practice I feel that I can make a difference. I’m very happy here and I’ve recently made a commitment to stay longer – possibly long-term”, said Frank. What are some of the challenges you’ve faced working in Aboriginal health? “The need to get to know your patients well, and to take into account their culture, history and background. That’s why it takes much longer for health professionals in Aboriginal medicine to gain acceptance and trust than it is in ‘mainstream’ practices. However, it can be incredibly rewarding to be able to change things through a long-term effort. Another big challenge is to deal with survivors of abuse and institutionalisation and to listen to their sometimes incredibly sad and shocking stories, which can be emotionally overwhelming. I ask myself ‘if I am overwhelmed just by listening, how must it feel for the people who actually suffered the abuse?’ And I am reminded how resilient they are. As a result it can be difficult to switch off. That’s why it’s so good to have this [group], because you can

unwind, re-energise and debrief with colleagues during work and function better afterwards”, said Frank. “Aboriginal people tend to suffer more chronic diseases and mental health conditions. As a result, consults take longer and are often more complex, so ‘group-time’ is important to refresh and prevent burn-out. I think a healthy lifestyle with time reserved for exercise can be an effective way for both patients and health professionals alike to help deal with their stresses. The other benefit is that we are seen by the community to practice what we preach,” said Ben. “It’s really difficult for some clients to find the time to exercise, eat healthily and maintain a healthy lifestyle so just by being able to say that this is something that we do, we help to inspire healthy behaviour in our patients. Inspiring them to make that decision to go out and try something new is really important to us”, Ben added. When asked about whether this group is something they would like to see happen full time, the response was clear: “Absolutely! We would like to keep this going, ideally once a week – it actually depends on our Practice Manager Emma because what we’d really like is two hours off – once a week!” Frank said. “Since we work as a multidisciplinary team, a lot of the time we all see the same patients on

Frank

the same day. If there’s been a drama or an issue come up in the morning, chances are that it has affected all three of us so we discuss it on the drive here. Debriefing, team building, bonding -we called it a men’s health group, but theoretically female staff could come,” said Frank. “…theoretically?” laughed Liam and Ben. “Blake, one of the Emergency Physicians said during a simulation course that one of the most famous (skateboarding) brands is Fallen because the best skateboarders have fallen in order to get better. If you get a setback, don’t let it drag you down, use it to learn from it,” Frank added. Has your Practice Manager been supportive of this group? “Very supportive so far! I had a chat with her and explained that with dropping in (to the skateramp) you need full commitment to make it. If you waver or hesitate you will fall, so it’s really all-or-nothing. I think that really also reflects our jobs in Aboriginal health.”

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New funding for virtual consultations Under the My Health Clinic at Home (MHCAH) pilot, GPs will be reimbursed for undertaking virtual consultations via video conferencing equivalent to a 20-40 minute consultation. The pilot is a part of the NBN-enabled Telehealth pilot program in Coffs Harbour (Mar 2012 to 30 June 2014), funded by DoHA and operated by Feros Care. Seniors over 65 years of age living with a chronic health condition are eligible for referral to the Feros Care MHCAH pilot. The program will focus on providing patients with daily monitoring of their vital signs and the ability to virtually connect with their GP, specialist, case manager and significant others from their home. For the term of the pilot, patients will be provided with

a touch screen tablet computer, monitoring equipment, NBN and internet services. The service is free of charge. Where agreed and viable, patients will be able to attend virtual consultations with their GP, specialist, or case manager.

Patients are also equipped to make video calls to their family and friends. Please note that a GP Practice does NOT need to be connected to the NBN in order to participate. Feros Care will provide both

technical and financial support to general practices managing clients on the pilot. The practice can access technical help for initial setup of their video connections with their patients on the pilot. In addition, a $70.30 rebate equivalent to a 20 to 40 minute virtual consultation (via video conference) from the practice to the patient in their home (in line with MBS Item # 36) will be paid. This rebate is in recognition that there may be some extra time required to establish the virtual connection. Feros is very excited about the potential of the MHCAH, for both seniors and health professionals. To refer your patient or to discuss the pilot, please call Feros Care on 1300 851 773 or go to www.feroscare.com.au

UVB phototherapy can tame psoriasis Cath Bird is a UVB phototherapy nurse in Coffs Harbour, working in a program at the Mid North Coast Special Outreach Clinic funded by North Coast Medicare Local. Ultra Violet B phototherapy is particularly helpful for patients suffering from the disfiguring skin condition psoriasis as the UVB rays penetrate the skin and slow the growth of affected skin cells. Patients come three times a week for their treatment at the clinic and enter a booth where the light rays are applied. The usual course of treatment is 10 weeks and the Coffs Harbour UVB phototherapy booth attracts patients from as far away as Grafton and Nambucca. Cath trained as an enrolled nurse at Coffs Harbour Base Hospital and worked there for 20 years in between raising four children and running a small business. Now married to a police officer, Cath explains she had to make some changes to her work routine. “It simply wasn’t feasible to

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Lino’s back before treatment...

have two shirt workers in the one house, so that’s when I went to work in general practice and two years ago I got this job, which I love. I’m very lucky to work under Dermatology Nurse Jan Riley who made me want to learn again and retrain as a phototherapy nurse. She’s a real inspiration.” Cath really enjoys her work as she gets to provide ongoing support and care to her patients as they journey through their treatments.

...and after treatment.

And last year, Cath’s exceptional commitment to her patients was recognised when she won the Bernadette Meyer Travel Award to attend a national dermatology conference, through the Australian Dermatology Nurses Association One of Cath’s patients, Lino Feltrin, wanted to share with HealthSpeak readers the positive outcome of his UVB treatment. “I have had psoriasis for the last 18 years! It started out as a few spots eventually covering

approx. 90% of my body. Having read all the literature on psoriasis with causes such as heredity, stress, lifestyle etc, I tried to attend to the possible triggers,” said Lino. After using multiple creams and medications with no improvement at all to his psoriasis, Lino was losing large quantities of flaking skin. “I was embarrassed to wear shorts or short sleeve shirts and definitely not swimmers in public. People always would stare or comment,” Lino told HealthSpeak. Lino’s GP referred him for UVB Phototherapy treatment at Coffs Harbour and he is delighted with the results and with the care he received from the clinic’s staff. After 10 weeks of treatment, and I must say without changing my lifestyle, I have had an outstanding successful outcome with no active psoriasis at present.” The images of Lino before and after his UVB treatment show a remarkable difference after 10 weeks.

HealthSpeak

winter 2013


Improving osteoporosis management following low trauma fracture in a regional setting: The Coffs Fracture Card Project By Dr Peter Wong PhD, GDClinEpi, FRACP

Osteoporosis (OSP) affects nearly two million Australians with an annual cost to the Australian community of $7.4 billion. Approximately 11% of men and 27% of women aged 60 years or over are osteoporotic. OSP is associated with low trauma fractures (trauma equivalent to a fall from standing height). Common sites are the wrist and hip. Patients sustaining a hip fracture have a 33% mortality rate in the following 12 months, with up to one third of such patients requiring admission to residential care. Regardless of fracture site, a low trauma fracture (LTF) is associated with an increased risk of another fracture for up to 10 years, by which time up to 60% of surviving women and men had suffered another fracture. Despite widespread availability of effective medications for osteoporosis under the PBS, following an LLTF, less than one quarter of patients are commenced on these treatments. Rural patients are less likely to be tested and treated for OSP than those in capital cities. We attempted to improve OSP testing and treatment following an LTF in the Coffs Harbour region with minimal additional resources. We designed a “Fracture Card� containing the following four questions (see figure):

Briefs

Native plum study Southern Cross University is investigating the health benefits of the native Davidson plum. Prof Stephen Myers and Dr Don Baker are seeking participants for a study looking at the antioxidant and anti-inflammatory effects of

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winter 2013

1. Has a bone densitometry test by dual energy x-rat absorptiometry or DXA scanning been done to see how thin the bones are? 2. Has the serum vitamin D level been checked as vitamin D is important in strong bones and muscles? 3. Has treatment for OSP been started - if appropriate? 4. Have fall prevention strategies been discussed? The Fracture Card was given to every patient presenting to Coffs Harbour Health Campus (CHHC) with an LTF along with a verbal explanation about the importance of being tested, and if appropriate, treated for OSP. Each patient was encouraged to attend their GP with the Card to discuss the four questions. The main capture points were the Orthopaedic Fracture Clinic and Orthopaedic Ward at CHHC and the Rehabilitation Ward at Baringa Hospital in Coffs Harbour. This was supported by a public health education campaign involving advertisements in the local newspaper and educational meetings for healthcare professionals After two years, the number of vitamin D assays and DXA scans ordered in Coffs Harbour had increased by 40%. However, there was no difference in the number of new PBS-subsidised prescriptions for bone protective therapy. These findings suggested

the fruit. Davidson’s plum has been a staple of the Indigenous diet for thousands of years. Blackmores is financing the study and providing the study medication. During the study, participants will take a 100mL daily dose of an active medication for a fortnight, which is approximately equivalent to eating four Davidson’s plums per day.

Dear doctor, your patient

   

has had a fracture and may have osteoporosis. Please help prevent the next fracture by conside ring the following: 1) referring for a bon e mineral density (DX A) scan 2) checking the serum 25- OH vitamin D aim ing for a level > 60 nmol/l 3) starting one of the following as they now qualify for PBS - subsidised trea tment: / bisphosphonate (rise dronate, alendronate or zole dronate) / strontium / denosumab 4) advising about falls prevention

Thank you.

The Coffs Fracture Card team

This is a collaborative project involving *!"&(*! &)* (*!("*") #"%" *!"&(*! &)*  ",")"&%& %(#(*"*! &)(&+(#*!  $'+)(*!&'" %!.)"&*!('. Departments and Barin ga Private Hospital. USEFUL WEBSITES

www.osteoporosis.or g.au

www.rheumatology.o rg.au

USEFUL REFERENCES /(,%*"% &)*&'&( &)")&+*&$)&*!+) *(#"% (*+( Prevention Summit. Med J Aust 2002;176:S11-S 16. /"*$"% %+#* &%!#*!"%+)*( #"%-#% a position statement. Med J Aust 2005;182 (6):281-285.

a public health education campaign and provision of a “prompt� for GPs was only partially successful at improving OSP management post-LTF. This has driven establishment of a more targeted approach via a Fracture Liaison Service at CHHC where all patients presenting to CHHC with an LTF are identified by a Fracture Liaison Coordinator. They are then referred to a dedicated Fracture Prevention Clinic where a bone health management plan, including commencement of medication for osteoporosis if appropriate, is implemented by a rheumatologist. Patients are discharged back to their GP for ongoing care after two to three visits. They are also contacted by phone at 12 months by the

Fracture Liaison Coordinator to ensure they are still taking their OSP medication. Referrals to the bulk-billing Fracture Prevention Clinic may be faxed to: Fracture Prevention Clinic, Coffs Harbour Health Campus, fax: 6656 7687. This Clinic can be discussed with Sandy Fraser (Fracture Liaison Coordinator) on 6656 7643 between 9am and 3pm Monday to Friday. *The Fracture Card Project was a joint undertaking between the Mid-North Coast Arthritis Clinic, Mid-North Coast Division of General Practice (now North Coast Medicare Local), Physiotherapy and Orthopaedic Departments, CHHC and the Rehabilitation Ward, Baringa Hospital. 17


Workforce research: GPs want flexibility and business support

Dr Sabrina Pit

A research project involving a survey and interviews has gathered information on what measures and support would help Northern Rivers GPs to remain in the workforce. Authored by Vibeke Hansen, research associate at the University Centre for Rural Health (UCRH) in Lismore, Dr Sabrina Pit, and senior research fellow Peter Honeyman, the project was supervised by Prof Lesley Barclay, the Director of UCRH. The work was funded by a Sydney Medical School Early Career Researcher grant and the University Centre for Rural Health. Dr Sabrina Pit was funded by a NHMRC Research Training Fellowship. Sabrina Pit told HealthSpeak that the researchers wanted to look at the positive aspects of how to keep GPs in the workforce. Conducted with the help of the Northern Rivers General Practice Network, who provided valuable GP data, work began on the project in late 2011. Firstly, the researchers sent out a short, anonymous survey to all GPs in the area over 45 years of age and to those whose date of birth wasn’t available. The response rate was a very pleasing 59%. Twenty GPs took part in the follow up in-depth interviews, as well as four GPs under 45 years of age. Sabrina said while some of 18

the group were highly motivated about their work and viewed general practice as their calling, others were already burnt out and tired. “It’s important to identify these weary GPs earlier, so they can be supported,” she said. Findings included the fact that there doesn’t appear to be enough talk about the gradual retirement of GPs and setting up a succession plan. A number also pointed out that there was no one to fill in for them when they were not at work. And while not surprising, Sabrina said the research demonstrated that the further away from the coastal strip, the tougher it is for GPs. “You can’t compare coastal GPs to those working further out and in single practices, in time we are probably going to lose our solo GPs and smaller practices. “While some were really burnt out and some not at all, I often heard the GP say ‘I’ve got it all under my control, but my colleagues, don’t. That’s an interesting statement. A lot of GPs said they do look after themselves, and maybe the ones interviewed did look after themselves and the others didn’t. “However, the survey results showed a lot of the GPs were overweight and didn’t exercise as much as they should. So it seems they are not as healthy in

their lifestyle behaviours as they make out to be,” said Sabrina. The research also showed that camaraderie was much valued among GPs and many older GPs said they missed the family gatherings that used to be organised by the Northern Rivers GP Network (NRGPN). They said they welcomed the opportunity to get together with other doctors and their families and have some fun. (Some years back the NRGPN organised a barn dance and camping at Bonalbo, a car rally, regular tennis days and weekends at Couran Cove with some education but mostly just fun activities, but these were curtailed because of insurance concerns by the NRGPN Board.) Here is a summary of the things GPs said would help support them to remain in the workforce: Having a specialist interest, eg allergies or

Briefs

Advance Care Planning The Federal Government is to invest $10 million to enable Advance Care Directives to be stored on the Personally Controlled Electronic Health Record. Speaking at the 4th International Society of Advance Care Planning and End of Life Care Conference in

child health. Suggested a data base be set up by NCML to let other GPs know of their particular interest, so patients can be referred. Flexibility in working hours Alternatives to ownership of a practice. Younger GPs don’t want to deal with the business side. Business support teaching more about managing the business side of general practice at student level Group social activities for the GP and the family Providing succession planning and gradual retirement Building on staff teamwork with regular practice meetings Changing legislation to allow retired GPs to mentor others and teach Improved communication between hospitals, specialists and GPs Making interns compulsory in general practice You can read an interview with Sabrina on the research here: http://www.news-medical.net/ news/20130320/Ill-health-andretirement-an-interview-withDr-Sabrina-Pit-UniversityCentre-for-Rural-Health-University-of-Sydney.aspx

Melbourne, Health Minister Tanya Plibersek said that it would ensure all Australians could have control over their end of life care.

Alzheimer’s drugs Many with Alzheimer’s disease will benefit from changes to the PBS which will simplify access to drugs. Barriers for continued access to donepezil, rivastigmine, galantamine and memantine were reduced from 1 May.

HealthSpeak

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Tweed’s first CIS breakfast event Mobile education resources, online social health games, and ‘HealthPathways’ were the innovative topics presented at North Coast NSW Medicare Local’s Copernican Inversion Series (CIS) breakfast, held on 22 May in Tweed Heads. CIS breakfast events are a coming together of the healthcare community – clinicians, service providers, administrators, consumers, volunteers, policy makers, educators, and researchers – to share innovation and ideas to bring about change. Around 50 people attended the event which featured presentations by Dr Keri Moore from Southern Cross University; Horst Thomson, Director of A Healthy Competition; and Dr Dan Ewald, Clinical Advisor, North Coast NSW Medicare Local (NCML); and was hosted

A still from the video about the Interactive Life Series project.

by NCML Board member, Dr Di Blanckensee. Keri Moore showcased images of SCU’s ‘SIM Truck’. The one of a kind innovation comes with a complete simulation for training across many health disciplines, and can be used to

NCML promotoes Healthy North Coast

provide preventative and chronic outreach care to patients in rural and remote communities across the North Coast. Horst Thomson presented on the power of social media games to inspire people to make healthy lifestyle changes and sustain them through support, recognition and reward. Dan Ewald explained the local implementation of Health

Pathways, an online information portal for General Practitioners and other health professionals on how to assess, manage and refer specific clinical conditions in the local context of available services. Each pathway is developed jointly by self-selected health professionals working together with help from a facilitator, and is guided by best-practice guidelines. Dr Sharon Dean and Greg Price from Maranoa Centre at Alstonville, who were awarded the most outstanding PITCH (Practical Ideas To Change Health Care) the previous evening, shared a moving video of their Interactive Life Stories project with the audience.

Port Super Clinic progress It’s expected that demolition work on parts of the former Lourdes Nursing Home in Port Macquarie will start soon, to make way for the $7m super clinic on Clifton Drive. In 2011 the federal government signed off on an agreement with Rural and Metropolitan Health (Port Macquarie) to establish the super clinic. After hours services, GP bulk

billing and allied health care will operate from the practice after internal renovations make the building suitable for a high quality service. The clinic will include 11 GP consulting rooms, three allied health rooms and nine multipurpose rooms. Pathology and x-ray will also be on site. Nearly 100 parking spaces will be available.

Record growth in organ donor rates

NCML’s Mid North Coast Branch ran a popular stall at the Coffs Harbour Health Expo in May and was delighted to sponsored an award at the MNCLHD’s Health Innovation Awards dinner held that night. From Left: NCML CEO Vahid Saberi and Shab Tavakol, Program Officer - Marketing and Stakeholder Relations.

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Australia’s official organ donor rates have increased to record levels for the first quarter of 2013. Figures from the Australia and New Zealand Organ Donation Registry show consistent record growth in organ donation and transplantation month on month this year. Parliamentary Secretary for Health and Ageing Shayne Neumann announced that “In the first quarter of 2013, the national outcome of 119 donors is a 55% increase on donors for

the same period for 2012. This means 70 more people have benefited from a transplant in just the first three months of this year, compared to the same time last year. “In March alone, we achieved a new national record of 50 donors, the highest monthly deceased organ donation outcome since national records began. The average monthly outcome was less than 20 donors prior to the DonateLife Network being established in 2009, so the increase is significant.” 19


The Koori Grapevine Promoting Good Health In the last little while NCML’s Coffs Harbour Closing the Gap team have been promoting good health to the community at two Walk the Talk with the Mob events – one at Grafton Showgrounds and one in Coffs Harbour. The Grafton event was held in collaboration with staff at Bulgarr Ngaru Medical Aboriginal Corporation in March. The day long event featured health information stalls, blood glucose and blood pressure testing and health checks. There were also activities for children – entertainment, music and dance, and a BBQ lunch with a bush tucker theme. Well-known Indigenous man Jeremy Donovan was the inspirational keynote speaker. Jeremy shared the story of how rediscovering his culture allowed

From left: Terry Donovan from NCML’s Closing the Gap Team, Jimmi Hand and his daughter Xanthi from The Yellomundee Family Band.

him to change his life’s direction and make conscious changes to improve his situation. At the later Coffs Harbour event around 300 people came along and it’s estimated that two-

thirds took advantage of the eight different health checks offered by staff from Galambilla Aboriginal Medical Centre. Guest speaker Tania Major, a proud Kokoberra woman

from the remote community of Kowanyama in Cape York, Queensland, told those present that health was a journey and that at the end of the day health was your responsibility. Tania is a wonderful role model for Aboriginal women and girls, having lost 25kg by researching and learning about how foods affect health. She also spoke about the need to make general practices more welcoming for Aboriginal people. NCML’s Closing the Gap Outreach Officer, Terry Donovan, said the Aboriginal and Torres Strait Islander community responded very positively to the health messages and checks available on the day. “And they have asked for a similar event to be held again,” he told HealthSpeak.

Deadly Moves changes lives A grandmother of seven has a new lease on life after taking part in a North Coast Medicare Local healthy lifestyle program, and is now enjoying aqua aerobics with a group that grew out of the program. Sue Follent of Bogangar told HealthSpeak that the 10-week Deadly Moves program, run by Bugalwena General Practice staff Rebecca Palmer and Jessica McCormack, had resulted in a drop in both her blood pressure and her blood glucose levels. The Deadly Moves program, which finished in April, included beach walking, linedancing, ten-pin bowling, aqua aerobics and low impact exercise sessions with 15 women taking part ranging in age from 32 to 79. “If it wasn’t for Deadly Moves I wouldn’t have thought to get back in the

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For me it was a big change and now I’ve got more energy. water, which I really love, and now every day is taken up with bloody exercise and when I get too fit, I’ll blame Rebecca,” Sue said with a laugh. Sue worked in health for 30 years and is now a member of the Bugalwena Advisory Group. She admits she has always been good at giving other people advice about their health but not so good at managing her own weight. “Deadly Moves really raised my awareness about fitness and exercise and I’ve got more of an idea about where my health is at now and what I need to push it into line and get fitter,” she said.

Koori Grapevine

Bugalwena’s motivating staff: Front from left: Rajarni Maher Paulson (Receptionist), Lyn Henderson (Practice Manager). Back: Dr Deirdre McCormack, Chris Edser (RN), Rebecca Palmer (Health Practitioner)and Jessica McCormack (Dietician).

Although an energetic person, Sue hadn’t been doing any regular exercise. “For me it was a big change and now I’ve got more energy, it gives you a bit more ‘oomph’.” Eight women from the

Deadly Moves group have now started a weekly aqua aerobics group of their own at Kingscliff pool. And Sue has even taken her grandson and granddaughter

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Vital snapshot of Aboriginal health in Northern NSW The chief author of a report that has pulled together available primary data from various sources on health and disease in the Northern NSW Aboriginal community, hopes it is used by North Coast Medicare Local, the Local Health District, the community sector and health professionals to plan future programs and services. Public health physician Dr Michael Douglas compiled the paper, Northern NSW Health and Disease in the Aboriginal Community, on behalf of Casino Aboriginal Medical Service, Bullinah Aboriginal Medical Service, Northern NSW Local Health District, the University Centre for Rural Health and North Coast General Practice Training. It was launched at an Aboriginal health seminar held in Lismore in late March to break down the continuing health disadvantage of Indigenous communities in Northern NSW. During the compilation of the report, community consultations were held in Lismore, Tweed Heads and Casino. It provides a snapshot of the current situation and “the opportunities that exist”. In his foreword to the report, Michael said that the paper reaffirmed the stark and unacceptable difference in health status that exists between the Aboriginal community and the nonIndigenous community. “We may well argue that we do not need to be told again – it is a part of every Aboriginal person’s life every day, and ought to be at the forefront of effort for every health practitioner and every health manager. Yet sadly, it is not,” he wrote. The snapshot of maternal and infant health shows that perinatal mortality rates in Aboriginal mothers remain at least 1.5-2 times that of non-Aboriginal mothers; Aboriginal baby birth weights are nearly twice that of the non-Aboriginal community and that 15% of Aboriginal mothers are under 20 years of age when they give birth, compared with 6.1% of all births in Northern NSW and 3.5% of all births in NSW. Additionally, 44% of Aboriginal mothers have

The report looks at disease in terms of life stages. smoked during the second half of their pregnancy. Aboriginal infant mortality while declining, is still 1.5 times that of non-Aboriginal infants. And in the area of mental health, 23% of Aboriginal children are at high risk of clinically significant emotional or behavioural difficulties (non-Aboriginal 9%). Michael said while many areas remained unacceptably wanting, some encouraging improvements in pre-term births and infant mortality showed that positive effort could make a difference. He told HealthSpeak that the paper arose from a working group of eminent health managers who charged him with the task. “I was asking why are we doing a program around ABC? What do we know about strongyloides in the community and are we tackling strongyloides in the community or TB? I was asking these questions and having difficulty finding the answers. “We should consider this paper as a work in progress, the first step in a stronger journey around how we think about health. There are lots of [data] gaps and things people might want to know about. They are very evident and we need to look at

those gaps,” he said. The report is not framed in disease groups. It starts by setting out the demographic profile and then looks at disease in terms of life stages. “We’re not looking at diabetes or sexual infections. We’re looking at ‘if I’m an adolescent, what are my health issues and what are my strengths?’ And so you can plan to meet the health needs of those individuals and look at them in an integrated manner,” Michael explained. The life stages included are maternal and infant health; child health and adolescent health. There is also a section on determinants and contributing factors to health and disease and a section on health and disease: a selected overview and a summary of services, workforce and resources. “We haven’t done anything with adults or elderly people. Because in many ways what we see in the elderly is reflected in the chronic disease data. The report also summarises the services we are providing and the workforce we’ve developed and whether these actually align with the health needs,” Michael said. A report compiled from available data naturally has its weaknesses and strengths. Michael said he’d used local date wherever possible, but where that was not available, he’d gone to wider state-wide data. “I found it very difficult to

do the service profiles and the workforce profiles, very difficult - that’s a weak part of the report. “And the data itself is imperfect. A lot of the data I’ve used would not pass the test of integrity from the epidemiological perspective, and I’ve tried to give those caveats throughout the report, saying this is a snapshot it’s not a report, yet not dismiss the data which has been collected and does tell a story.” Michael believes ‘the information in the report should inform planning by the community sector to drive change within the community … making genuine effort that health interventions are founded on evidence of benefit. Errors or omissions identified, and other additional sources considered of importance should be forwarded [to him for future reports]. He is optimistic about the way forward. “The report signals the ongoing need for a positive approach, another rallying call that health managers hear the community, and build upon their strengths.” Concluding the report’s Foreword Michael says: ‘This collation is one step in the journey – acknowledging that there are many more steps ahead. Every one of us has a responsibility to address the disadvantage. If we each believe in the cause, collectively we will find the ability to do so’.

From page 20 along to join in. Sue said Rebecca and Jess had been very encouraging and she appreciates the hard work they both put in to get the program up and running so well. “They were both terrific and I like the fact that everything’s organised for you. I appreciate that very much,” Sue said. To find out more about Bugalwena services and programs, phone Rebecca on (07) 5513 1322.

Koori Grapevine

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Arts Health and Wellbeing SPRUNG!! surges ahead It’s been an exciting few months for the Alstonville dance group SPRUNG!! The group, started by dance teacher Sue Whiteman and paediatrician Robyn Brady, has become incorporated and interest has grown, with a range of talented people stepping up to take on roles to move the new organisation forward. Sue has been teaching people with a disability for around 25 years and after their inaugural integrated dance theatre holiday workshop last September , the organisation is preparing for a new creative development called dwell. When HealthSpeak visited the Alstonville Dance Studio in late April, a four-day workshop was underway with around 40 people from diverse backgrounds and with a range of life experience working with choreographers Philip Channells, Creative Director of Dance Integrated Australia; Sue Whiteman and NORPA’s Philip Blackman. Dancers from SPRUNG!!, Red Inc and the wider community were working in preparation for the dance performance which is part of a Triple Bill program happening later this year, funded through a grant from the Arts and Disability

Philip Channells

Dancers in rehearsal for the exciting triple bill program ‘dwell’.

Everyone has a story and it’s satisfying to work with people and encourage them in their creativity. Funding Program from the NSW Government. dwell, to be held at the Byron Community Centre in September, will comprise the dance performance, an Industry panel and an art exhibition. Also seen at the Northern Rivers Community Gallery in Ballina in April, was an exhibition featuring photos by Katrina Folkwell and Sarah Kearney of

last September’s dance workshop. Philip Channells came to dance late at the age of 28 and began his dance training at the Conservatorium in Lismore before joining the Adelaide College of the Arts and Link Dance Company at the Western Australia Academy of Performing Arts. Philip told HealthSpeak that

Philip that he was strongly committed to developing disability arts through redefining an artistic practice that integrates people from diverse backgrounds. He sees dwell as being about the way we inhabit our bodies and lives and he’s enjoying the process of drawing creative expression out of a broad range of dancers. “Ever one has a story and it’s tremendously satisfying to work with people and encourage them to use their individual expression in a creative way,” he said. To find out more, about SPRUNG!! contact Sue on 6686 2520.

Prescribing newer anticoagulants In light of the Pharmaceutical Benefits Advisory Committee’s (PBAC’s) recommendations that dabigatran (Praxada), rivaroxaban (Xarelto) and apixaban (Eliquis) be listed on the PBS, NPS MedicineWise says GPs must consider the safety and efficacy of newer therapies in context with warfarin. “There is a need to establish good anticoagulant practice in Australia and a decision to sub-

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sidise newer therapies would present GPs with a choice which needs to be weighed carefully against the alternatives,” said NPS MedicineWise CEO Dr Lynn Weekes. She said the risks and benefits of newer medicines need to be carefully weighted up along with the safety issues involved in switching therapies. Dr Weekes said evidence suggests that people with non-valvular atrial fibulation

whose anticoagulation is well controlled using warfarin may not benefit clinically from switching to a newer medicine. “And while the new oral anticoagulants don’t require monitoring with a blood test, there is significant risk for the patient because there is no readily-available antidote to reverse bleeding should it occur when using these newer agents,” she added. NPS MedicineWise

launched a new program for health professionals around anticoagulants which provides support for GPs in their decision making and helps the pharmacist feel more confident in advising and educating patients requiring anticoagulant therapy. For information about the program, visit: www.nps.org. au/anticoagulants

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The art of living with depression Zip had often talked about art classes but never got around to it.

By Janis Balodis The object of art is to give life shape. – Jean Anouilh. My youngest brother Zip was diagnosed with depression almost ten years ago. A boilermaker by trade, Zip was a bloke who liked a drink and a smoke, and had a ute, a dog and a cat. Returning to work after a lengthy lay-off with a shattered ankle was always going to take a period of adjustment, or so we thought. Zip’s GP advised him to stop work while he tried different medications to alleviate his moods and anxiety. Zip had a difficult three-month wait to see a psychiatrist and continued to work part time to help out a friend. None of Zip’s family took it too seriously – until he broke off a burgeoning relationship, sold his house and moved one hundred and fifty kilometres away from immediate family to a 10-acre rock-farm with a livable shed. Zip needed to escape but he had just turned fifty and would still have to earn a living. After two years of part time work, regular visits to a psychiatrist and different medication, Zip went back to fulltime work as a drive-in drive-out worker at a mine near Charters Towers. He seemed to be doing so well the doctors advised Zip to reduce his medication. Within a short period of time Zip’s work and life became unbearably difficult. By 2010 Zip no longer had a job and was in the wars with Centrelink about applying for a disability pension. Zip had often talked about taking art classes but had never got around to it. Being away two weeks in three meant his down time had been taken up with chores on the rock farm and the shed was showing signs of neglect. Zip now had the time but some days he struggled to get out of bed except to tend his animals. Zip lives alone, out of town. Neighbours feed his animals when he is away but he has never really been a member of that community – until now. HealthSpeak

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Zip with his some of his vibrant art in his ‘liveable shed’.

Through art, Zip has found a community, a tribe, to support him.

Through art. In March of 2012 Zip had his first art lesson. He missed the first three or four weeks of an eleven-week mental health

program and produced what he now refers to as an embarassing painting for our brother’s sixtieth birthday. Zip was brave to gift it so publicly and our

brother was suitably gracious in accepting. Zip had found something. What’s more, he has gone on finding it. Not a great undiscovered talent though he gets better with every painting. Zip has found a way to give his life shape and meaning. Zip has found a way to express himself beyond the side-effects of his medication, his dark moods and rages. When he is painting Zip goes somewhere else, some soothing place where time passes without thought. He is becoming increasingly addicted. To art. He reads about it. He plans what he is going to attempt next, researches it and finds models to copy which he is now beginning to make his own. Much to his surprise and delight his work has been chosen as a lucky door prize and even attracted a buyer or two. More importantly, at the Art Shed every Wednesday Zip has found a community, a tribe, to assist, encourage and support him. And he assists them by welding up broken tables and signs and by looking after the gallery on Sundays. And Zip has goals for paintings and sculpture that put a note of excitement back in his voice and into his life.

Info hub for disability arts A new website has been set up to act as a central information hub, gig guide and blog to allow people living with a disability to fully experience and particpate in the arts. The website is a project of Accessible Arts NSW and Julie Barratt, Accessible Arts

North Coast Manager is keen for people to contribute to it and help promote accessible venues and activities happening locally. “The new website, Creating Connections, is about pushing boundaries,” Julie said. Dance, visual art events and workshops are just some of

the activities visitors will find at Creating Connections. Keep up to date with local news and opportunities as they arise, by visiting the website: www. aarts. net.au/northcoast or look for CreatingConnections on Facebook.

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Campaign to improve transport to health care In late February, an important report was launched at North Coast Medicare Local’s head office in Ballina to spearhead a North Coast NSW campaign for action to improve transport options for those going to health care appointments. The report ‘Provided there’s Transport: Transport as a barrier to accessing health care in NSW’, was produced by the Council of Social Service of NSW (NCOSS). It was completed with help from Kate Geary, Linda Wirf and Linda Mills from the Northern Rivers Social Development Council (NRSDC), who ran a workshop in Lismore in partnership with NCOSS, to identify the particular difficulties faced by patients in a regional area without a regular network of bus or train services. A Sydney workshop was also conducted. And last year NRSDC staff presented a PITCH at North Coast Medicare Local about the need to ensure patients can get to specialist appointments up the coast. For the past 15 years, the lack of support for health transport

“We hope that this report will act as a catalyst for action. We need to get out there and lobby MPs and really campaign to get these health transport problems addressed,” said Tony. Report recommendations include

Those attending the launch of the transport report assembled for a group pic to be used to help campaign for improved health transport.

on the North Coast of NSW has been identified as a significant gap in the health system, and of particular concern to the community services sector working on behalf of people experiencing disadvantage and for organisations supporting people with chronic illness. At the launch, Phil Barron from Tweed Byron and Ballina Community Transport spoke about the problems faced by so many in getting to

Creative writing for nonwriters: a weekend for health professionals North Coast GP Training is pleased to announce a weekend creative writing workshop, to be held in Lennox Head from 27 to 28 July to coincide with the Byron Writers Festival. The workshop, Transforming challenging patients into interesting people will be led by North Coast GP Training’s Senior Medical Educator, Dr Hilton Koppe. Hilton has a keen interest in GP wellbeing and recently returned from presenting a keynote speech in Iowa, USA at the 2013 Examined Life Conference. This weekend workshop will have a particular focus on using creative writing to maintain enthusiasm and to prevent burnout

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and compassion fatigue in clinicians. Participants will have the opportunity to use structured writing exercises to reflect on what it means to be a health practitioner, to develop skills in using a variety creative writing styles, to reignite previously lost passions for creativity, to marvel at the brilliance of their colleagues, to share some of their creative brilliance with colleagues (if they choose to) and to learn skills in using creativity in education. The workshop is open to all health practitioners and professionals. For further details or to register, contact amandas@ncgpt.org.au

important treatments such as chemotherapy or radiotherapy at Lismore Base Hospital. Mark Moore, CEO of Bullinah AMS also spoke about the difficulties Indigenous patients faced in getting to health appointments – often without a car and living out of town. Both Phil and Tony Davies, CEO of NRSDC, expressed frustration at the ongoing lack of support for health transport and concern over a widening gap.

Local Health Districts to work with North Coast Medicare Local to undertake joint planning on health transport needs and develop a coordinated response The NSW Government to clearly define policy and funding responsibilities in relation to health transport. Adequately staffed and resourced Health Transport Units and networks to be established or maintained in each Local Health District. To view the report, go to: http://www.ncoss.org.au/ resources/121206health-transport-report.pdf

Successful weight loss requires commitment Judy Martin is one of five clients at Gurgun Bulahnggelah Aboriginal Medical Service in Lismore who have lost more than 10 kilos with the help of dietician Abbey Calnan. Judy told HealthSpeak that she went to see Abbey in May last year. “I wanted to get some advice about nutrition and diet, I needed to lose some weight. Abbey’s been great at putting me on the right track – teaching me which foods to eat, how to exercise and suggesting a number of lifestyle changes,” she said. The key to Judy’s success it seems, are her regular appointments with Abbey every two weeks. “I feel so happy to have lost 13.5 kilos over the past 12 months. I seem to have a lot

more energy and I feel much better about myself,” Judy said. “Abbey has really kept me going.” Abbey explained to HealthSpeak that she conducts an assessment on each client and determines exactly what they are after. “Do they want a meal plan, or something more specific such as information on calorie control? It’s important to know what the client wants to get out of working with me,” said Abbey. She likes to use motivational tools when working with clients to improve their health and fitness. Abbey said it was terrific to hear Judy’s feedback on her successful weight loss. “She’s been really committed and achieved her weight loss the right way.” To refer a client to Abbey, call her on 0413 194 122. HealthSpeak

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Changes to Home Medicine Reviews are Widening the Gap By Lindy Swain The Home Medicines Review (HMR) program was introduced in 2001 by the Commonwealth Government to help those living at home maximise the benefits of their medication regime and prevent harmful consequences of medication misuse. HMRs have been found to be important in raising awareness of medication safety and reducing adverse events and hospital admissions. Research indicates that 30 per cent of hospitalisations among the elderly are due to medicine reactions. In February, The Pharmacy Guild of Australia wrote to the federal government calling for a moratorium on the HMR program. However there was a great outcry from consumer and pharmacy groups as patients greatly value this program. Chief Executive of the Consumers Health Forum, Carol Bennett, said ''these programs offer enormous benefits to the consumers who most need them, and that's older people, people who take high-risk medications or multiple medications.'' Federal Health Minister Tanya Plibersek overturned the moratorium call stating that “HMRs provided by accredited pharmacists in patients' homes deliver very real and tangible health outcomes for around 77,000

Briefs

Infectious diseases The Federal Government has announced a medical research partnership with the Singapore Government to fight three of the most infectious diseases in the region. Joint funding of $3.5 million will support five research teams based in Australia and Singapore working on projects that will address diseases including TB, dengue fever and influenza.

HealthSpeak

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From left: Laura Little,pharmacist; Deborah Lynwood, patient; Jim, Aboriginal Health Worker.

Australians each year. Reducing preventable medication misadventure is too important”. While it is pleasing that the Minister has shown support for HMRs by guaranteeing funding until 2015, the new rules for the program are in a “one size fits all” format which will result in some of the sickest people in tour community being unable to access this service. While it is acknowledged that the home is the ideal setting for the HMR interview between patient and pharmacist, some patients are not comfortable with a home visit. Many Aboriginal and Torres Strait Islander patients are not comfortable having a “stranger” in their home and would prefer to have their HMR conducted at their Aboriginal Medical Service. Changes to HMR rules announced in March specify that all interviews must be conducted in a home, or approval sought at least 10 days prior to the HMR interview. There are a small number of pharmacists working within AMSes assisting Aboriginal patients with complex chronic disease and medication management. Conducting HMRs within the Aboriginal Medical Service gives the pharmacist a private consulting room, access to Medical Director or other patient health records, access to Aboriginal Health Workers, nurses and doctors and a trusted place within the primary health care team. HMR accredited pharmacists may make a submission to

The one size fits all format will see some of the sickest people unable to access the service. complete the patient interview in an alternate site, such as an Aboriginal Medical Service, but this lengthy paperwork must be submitted at least 10 working days prior to the proposed service. HMR accredited pharmacists working in Aboriginal and Torres Strait communities often do not have the luxury of these time frames. Laura Little has been conducting HMRs in the Galambila Aboriginal Health service at Coffs Harbour for three years. As Laura says, “becoming part of the Galambila team has been an integral part of the success of the HMR service there. It took time to build trust with patients and staff ”. Laura visits Galambila fortnightly and conducts around six HMRs per visit. Many patients are identified and contacted the week before the HMR. The HMR appointment is tied in with other health visits and the availability of transport and Aboriginal Health Workers. Poorly compliant or transient patients are identified on the day. The doctor and/or Aboriginal Health

Worker provides the patient with an information pack about Laura and the HMR process, then the HMR is conducted in a Galambila consulting room. Laura says “if the HMR was not conducted in the health service then patients would miss out all together, as it can be culturally inappropriate for me to go to someone’s home. For the patients to talk with an unfamiliar person about their health, a familiar place is essential”. Laura’s recent claims for payment for HMR services conducted at Galambila have been rejected by the Department of Health and Ageing (DoHA). A number of groups have been lobbying for Aboriginal Health Services to be exempted from the new HMR rules, but to date DoHA has not agreed to these suggestions. It will be a huge travesty of justice if Aboriginal patients are unable to access HMR services. Laura laments “so many patients need assistance with their medicines. “We are starting to see real benefits. Let’s hope someone sees sense soon”. More information about the HMR Program may be found at: http://www.medicareaustralia. gov.au/provider/pbs/fourthagreement/hmr.jsp Or by contacting Lindy Swain on lindy.swain@ucrh.edu.au Lindy Swain is the Pharmacist Academic at the University Centre for Rural Health, Lismore. 25


Talking about vasectomy Having performed vasectomy procedures for the past 20 years, Dr Greg Anderson is more than happy to discuss the procedure with any man wanting a highly effective and permanent method of contraception. Dr Anderson told HealthSpeak that vasectomy was a simple procedure, normally taking less than 20 minutes. “It should not be stressful and does not require an anaesthetic, the patient is able to talk comfortably throughout the procedure,” he said. Dr Anderson performs NoScalpel Vasectomy using the Li method. With this technique the skin is still cut under local anaesthetic but the cut is carried out using a pair of sharp, pointed forceps. Whether a scalpel or forceps are used the procedure should produce minimal trauma to the tissue. At Dr Anderson’s Gold Coast Clinic, an initial consultation is always required for discussion and an explanation of the vasectomy, as well as examination and the provision of a consent form. There is also an instruction sheet provided. Dr Anderson prefers that the consultation and the vasectomy are not on the same day to allow time for consideration. However, if patients need to travel significant

Lifestyle Medicine Conference coming up By Andrew Binns

Dr Greg Anderson

distances the vasectomy can be performed on the same day as the initial consultation. Both the initial consultation and the vasectomy attract Medicare rebates. Following a vasectomy Dr Anderson explained that patients would need to use another method of contraception for at least four months. This is because some sperm will be left in the tubes, and at least 20 ejaculations are required after the procedure before sperm are no longer present. To find out more phone The Gold Coast Vasectomy Clinic, located located within the Mudgeeraba General Practice, on 07 5530 2822. Or go to: http://goldcoastvasectomy. com.au

Sick of politics? Dreading election day? If so, there’s a remedy. Before our Prime Minister announced the election date, the Australian Lifestyle Medicine Association (ALMA) commandeered the weekend of 13 to15th September for its 5th National conference in Manly in Sydney. You can transcend politics (but still vote on site) by interacting with some of the best practitioners in lifestyle medicine and chronic disease management. Speakers include Rosemary Stanton (Environmental Aspects of Nutrition), Dr David Colquhoun (Depression and Heart Disease), Ex Iron-man Guy Leech on the value of being ‘Fit, Forty and far from F*****d’, and US Group Visits expert Dr Ed Noffsinger on the value of Shared Medical Assessments (SMAs)for chronic disease. In line with previous years, the conference theme ‘Eating ourselves and the planet to death’, tackles the big environmental issues in health as well as lifestyle, behavioural and

medical issues associated with most chronic disease. ALMA has broken new ground at past conferences by considering such broadranging approaches to health as the ‘obesogenic environment’ and weight control (Prof Boyd Swinburn), population control and health (Dick Smith), the health effects of economic growth (Ross Gittins) and faecal microbial transplants for gastro-intestinal disorders (Prof Tom Borody). Lifestyle Medicine as a discipline, contributes to, rather than conflicts with, conventional medicine. Where it differs, however, is in the need for combining effective processes of behaviour change with the epidemiological content required to manage the causes of chronic disease. US pioneer of SMAs, Dr Ed Noffsinger, will host a half day pre-conference session discussing the ‘nuts and bolts’ of how SMAs, including ‘Drop in Group Medical Appointments’ can work. For more info on the 5th ALMA Annual conference, go to www.lifestylemedicine. com.au.

Dementia diagnosis and management workshop Alzheimer’s Australia, in collaboration with North Coast Medicare Local, is

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running a one-day interactive learning module on June 22 in Ballina worth 40 Category one CPD points. The topic is: Improving Outcomes for a Timely Diagnosis and Management of Dementia in General Practice. The venue for this event is Ballina RSL and the day begins with registration at

8.30am and the workshop runs until 5pm. It is open to GPs, Practice Nurses and residential aged care facility staff. Speakers will be Dr Sharon Reutens and Dr Allan Shell. Learning objectives include Increasing awareness of current clinical guidelines for diagnosis and management of dementia Improving diagnostic acumen with respect to cognitive impairment Identifying factors in both the practitioner and patient that may be

potential barriers to the diagnosis of dementia Understanding the impact of a patient with dementia on family and carers and the community support and services available Implementing a system using screening tools for all patients over 75 in whom there is a concern about memory problem, for both cognitive impairment and depression. To register, email: l.caldwell@ unsw.edu.au HealthSpeak

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Need for Type 1 diabetes support group Now working two days a week in a supportive workplace, Monica said she sees each day as a challenge, but also a gift. She finds writing about her condition is helpful in dealing with the frustration of ‘bad days’. “I get these terrible days when I have a nauseous feeling in my stomach and a real pressure in my head. It's not a migraine, but

lasts right through the day. On these days I can't do a bloody thing and find it difficult to eat and manage my Type 1 Diabetes.   Writing helps me reason out these days – I definitely find it useful.” If anyone wishes to help start a support group, please email Monica at: thegilberts3@bigpond. com

Poem: Through The Eye Of The Needle Monica Gilbert wants to help young people manage diabetes better.

Monica Gilbert is a vibrant woman aged in her 40s, living in the Coffs Harbour area. At one appointment, Monica shared a poem she’d written about living with Type 1 diabetes with her diabetes educator, Denise Maxwell-Hopper, who is employed by North Coast Medicare Local. Monica’s honest and moving depiction of dealing with a serious illness appears on this page. Monica talked to HealthSpeak about her poem and about the pressing need for a local support group for Type 1 diabetes patients and her desire to get one going. “There is quite a lot of support for Type 2 diabetes, but Type 1 is a very different illness. My intention is to invite others to come along, talk freely about all of our concerns and establish a buddy system for those in my locality who want to participate,” she said. Monica’s motivation for setting up such a group is based on 30 years of living with Type 1 diabetes and experiencing its effects upon her life. First diagnosed with at the age of 18, Monica said she was naïve and just wanted to be like her friends. Not realising the risks to her health, she smoked a packet a day, drank and partied hard and said she’d experience hypos after a big night out . (Hypos are low blood sugar episodes which can make a person shaky, irritable, lacking in concentration and needing to eat.)

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“Around the ages of 23 and 24 I drank a lot and went to America with friends. Sometimes I wonder how I survived that trip as the consequences around drinking can be highly dangerous. But there wasn’t the education about managing diabetes like there is now or the counselling services or diabetic educators, like Denise,” she explained. Monica also spoke of her isolation around her illness in her younger years, often hiding it and feeling different. She sees a support group helping people of all ages, but in particular young people, to manage their illness better and providing support and advice on how to survive at school, in later studies and in the workplace. “It’s important that the people you work with understand your illness and accept the effects it can have on you. I might be a bit spaced out or need to eat something straight away and if people have an understanding about Type 1 diabetes then they will support you rather than criticise you,” she said. “When I was diagnosed , it was completely unheard of to tell your employer that you had to pull out a syringe at your desk, or worse still go into the ladies toilet (not very hygienic) and prepare your injection. I was not able to display my blood glucose monitor either.  As you can imagine, it can be life threatening to hide your illness from your employer.”

By Monica Gilbert

As I wake each day, I inject myself for my first needle which I must endure to live this way. Through the eye of the needle , I am familiar with this pa in and tell myself that I will see this through to end of the day. Okay the reading is fine which is good to know, as I get ready to walk to maintain the correct blood sugar status quo. However, Type 1 Diabetes does not always flow and there are many bumps, which I must overcome as I come to terms with the dangerous blood sugar low ! Before I leave on my daily walk , I take the world famous jelly bean , which is kept in my pocket, and hopefully won’t need , because afterwards my sugar levels normally skyrocket. Although , I repeat the same routine , it never seems to amaze me , that I must keep fit and healthy so you can hear my plea! The long term effects of this disease that are life threatening and my mother and father surely agree , that I must remain vigilant in my quest for a cure and stay strong and committed as I search through each and every door. As the day progresses, I jump in my car for a drive , but I am feeling shaky & hungry and realise that if I turn the key, I may not survive . This is my life and has been since; I was eighteen , who would’ve thought that my existence would depend on that bright red jelly bean . Times can be tough ; as I’m sure you would agree that the eye of the needle does not deceive . Lunch passes by without any glitches; I then must concede and take a well-earned break , before I allow myself my all important next feed . Depression and anxiety impact on my dreams but through the eye of the needle I am able to breathe . Living and loving with this chronic disease makes me aware of the importance of having to adhere to this bloody awful routine . My day with the needle has gladly reached its end , but to those that don’t know me , I hope I didn’t offend . You see it ’s not me who’s fighting with you, it ’s the Type 1 Diabetes that is making me feel blue and without you understanding the connection is few, so please take the time to explore all my avenues. Good night, sweet dreams, I will close my eyes once more , and thank the eye of the needle for hearing my cause .

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Nimbin Medical Centre: a special practice in a unique community It took a move from Nimbin to Lismore, for Kaye Bonato to appreciate the very personal style of health care she received at the Nimbin Medical Centre for more than 20 years. Nimbin Medical Centre is run by North Coast Medicare Local. Kaye told HealthSpeak that the Lismore practice she visited on moving to Lismore, was, by comparison, impersonal. And after a couple of appointments, she decided to return to Nimbin for her medical care. “At Nimbin Medical Centre you don’t feel that you are a number in the system. It’s more like the old-fashioned style of doctoring. You won’t get a doctor watching his clock – 15 minutes and you’re out. All the staff there are very caring and even though it means nearly an hour’s drive for me, I value the care I receive at Nimbin,” said Kaye. Kaye sees Dr Dan Oxlee at Nimbin and describes him as a ‘family doctor’. This active grandmother has type 2 diabetes and makes her appointments three months in advance, but in the event of her needing an emergency consultation, she says staff do all they can to fit her in. “Dan is just a nice guy, but I’ve

Kaye Bonato

seen various doctors there over the years and they’ve all exhibited a real caring. David Helliwell was special, as was Oscar Serralach and Kingsley Pearson. I now really appreciate the staff at Nimbin. I’m sure they see the best and worst of people there and I’ve always found them to be really compassionate and caring,” said Kaye. It was Nimbin’s artistic community which led Kaye to move there more than two decades ago. “There was a lot of art there and a lot of art being expressed through music, art and clothes, so that appealed. It was a much more artistic-minded community than generally found in small Australian towns.

Partnerships key to health reform In order to work as effectively as possible to keep people healthy and out of hospital, North Coast Medicare Local is in the process of establishing a working group of senior regional health service managers. This will be made up of NCML representatives and the Chairs and CEOs of the Mid North Coast and Northern NSW Local Health Districts. It will be a partnership for health structure and reform input. NCML’s Clinical Advisor Dr Dan Ewald said this would result in tying together processes and operations, so that the current health systems can act as one health system. “That will mean sharing the control and the funding for

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Nimbin Medical Centre: unique and caring

“And the countryside is really beautiful, lush. It’s a very accepting and self-aware community, they know they have a special community and work on fostering that. There are a lot of needy people in that area and I think they gravitate there because they are supported by the community as well as by the medical practitioners. I think they get a little bit more compassion than they would somewhere else.” Up to 2011, Kaye worked for six years for the Australian Air Force Cadets as a staff member, supporting cadets. Activities undertaken by the Air Force Cadets include flying, field craft, adventure training, firearms safety training, drill and ceremonial, service knowledge, aero modelling, navigation and gliding. Kaye said she loved her air force work. “It was wonderful, such an experience. I had been going to join the air force when I was 21 and I

Briefs

Vaccine Scheduler app Dr Dan Ewald

some shared programs. We are starting to realise that we need to invest in each other’s problems. And importantly, this new partnership will result in patient-centred care and improved health outcomes,” he said.

Vaccination Scheduler is a simple iphone app that sends reminders to parents about when their children’s vaccinations are due. With vaccinations now tied to childcare benefits, the app is a helpful device to ensure parents adhere to vaccination schedules.

loved flying and I got to fly in a lot of defence aircraft that you’d otherwise not get the chance to fly in,” she told HealthSpeak. When she’s not spending time with her family, Kaye can be found painting or producing mixed media artworks. She is currently undertaking three online art courses with overseas teachers. Kaye is also an advocate for the healing properties of art journaling. “I’ve been using it myself and its quite freeing of things that you might have churning around that you are not going to talk to someone about. They might be too personal, and this is a way to put it down, you see that you’ve put it there and then it can be covered up. You still know it’s there but nobody else sees that, they see a picture or some colours. It’s very big online and I see it as very therapeutic. A lot of people are using it as therapy.”

The app also tracks the vaccination history of up to six children and can email a PDF report directly from the mobile phone. Pre-Installed with all vaccination information, all that is required is to enter the child’s name and date of birth. To find out more, go to: www.vaccinationscheduler. com https://itunes.apple.com/ app/vaccination-scheduler/ id563213898?mt=8

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Full house at PTSD workshop

Your brain matters

Good news! Research shows that what’s good for the body and the heart will also be good for the brain. The sooner we adopt a brain healthy lifestyle, the better. It’s never too late, nor too early, to start! Research shows that the health of the body and the heart impacts on the health of the brain. They’re all connected To keep our brains healthy we need to keep our bodies and hearts healthy, and the best way to do

NCML staff from Tarmons House Mental Health Service held a Post Traumatic Stress Disorder Workshop in March which attracted 60 mental health professionals from the Queensland border down to Port Macquarie.

Free of charge and held at the University Centre for Rural Health in Lismore, the workshop’s keynote speaker was Mark Boschen, Senior Lecturer in Clinical Psychology at Griffith University in Queensland.

Government to establish Chief Allied Health Officer With allied health professionals making up around 20 per cent of the health workforce, the Federal Government is establishing a Chief Allied Health Officer’s role to support their work. Announcing the move, Federal Health Minister Tanya Plibersek said allied health professionals provided vital services to patients and the creation of a Chief Allied Health Officer’s role would further strengthen and support what they do. “Allied health professionals play a key role in patient care, especially for people with chronic and complex conditions, and the services that they provide are becoming increasingly important with an ageing population. “The Government recognises the work that allied health professionals do and the Chief Allied Health Officer will provide advice on how best to HealthSpeak

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strengthen their role,” said Ms Plibersek. The establishment of a Chief Allied Health Officer also responds to a recommendation of the Senate Community Affairs References Committee, following its inquiry into the factors affecting the supply of health services and medical professionals in rural areas. The committee found that allied health professionals face additional challenges in delivering services to regional, rural and remote Australia. While the Chief Allied Health Officer’s key focus will be improving the delivery of allied health services in the bush, all Australians are set to benefit from well integrated medical, nursing and allied health care services. North Coast Medicare Local is also working to make allied health services more effective and more accessible in local communities across Australia.

this is to exercise, eat healthy foods, and ensure you manage medical conditions such as high blood pressure, cholesterol and blood sugar. Combine this with a range of stimulating social and mental activities and you’ll be taking positive steps to looking after your brain, body and heart. In response to this research, Alzheimer’s Australia has developed the Your Brain Matters program to raise awareness about the actions we can take, especially in midlife, to help reduce our risk of dementia later. For more information on Your Brain Matters visit: www.yourbrainmatters.com.au

Community turns out for CTG event at Nambucca

A Closing the Gap event was held in March, hosted by staff from North Coast Medicare Local in collaboration with the Local Health district and Darrimba Maarra Aboriginal Medical Service. About 200 community members attended, including children from Giiguy Gamambi pre-school in Nambucca Heads.

From page 11 in the general population, he said. He concluded by saying that ‘in consideration of the benefits thus far identified, ‘there would appear to be an ethical imperative to approve medical cannabis use’. After the unanimous decision from the inquiry Hudson said it was heartening that the parliamentary committee has unanimously endorsed medical cannabis for certain uses. “If the recommendation becomes law, it will provide a much healthier legal and ethical environment within which to determine potential harms and benefits of cannabis,” he said. Hudson points out that the opinions he expressed in his letter to the inquiry are his and not necessarily those of the UCRH affiliate universities.

Bookmark HealthSpeak and read it online HealthSpeak is now on line and proving popular with more than 14,000 readers last issue. Bookmark it now at: www.issuu.com/ healthspeak

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Health students get ‘hands on’ with seniors

Port Macquarie X-Ray moves, expands

Students from Southern Cross University’s health and Human Sciences Department are getting valuable workplace training at aged care homes in Ballina and Lismore. The university has partnered with Crowley Care Services in Ballina and St Joseph’s Nursing Home in Lismore through a grant from Workforce Australia designed to improve clinical training of health students and workers in regional areas. Nursing, exercise physiology and occupational therapy students are basing themselves at Ballina, working out of the Uni’s mobile health facility. They are offering individual health assessments to Crowley’s independent lviing residents, residential care residents and community clients. Deputy Head of the School of Health and Sciences, A/Prof Wndy Gilleard, said the work placement provided students with real world experience of interacting with people over 65. “Health workers seeking to work in this area need to be senstiive to the needs of older Australians when delivering care and support,” she said. Crowley Care Services CEO Michael Penjey said the project was a terrific scheme. “It provides invaluable onthe-ground training for our region’s students and delivers vital services right to the doorstep of

In April, Port Macquarie X-Ray moved from its temporary Parker Street site to its new purpose built premises at 65 Lord Street. As well as a brand new building, Port Macquarie X-Ray will be offering new services in a phased rollout. Currently at the new Lord Street building, Port Macquarie X-Ray offers:

Crowley resident Robyn Carlill doing a strengthening exercise with Master of Clinical Exercise Physiology student Lauren Woods. CREDIT: Sharlene King/ SCU

our residents and clients.” Project leader Dr Louise Horstmanshof said the scheme would provide valuable feedback from older patients to help develop relevant health care for the aged. The Primary Health Care for Older People Projeect is expected to be rolled out at Crowley’s sister facility on the Mid North Coast – Sawtell Catholic Care of the Aged – in the middle of the year.

Ingenuity 128 Slice Low Does CT including cardiac and angiography Digital general X-Ray iU-22 Ultrasound including general, musculoskeletal, vascular and accredited obstetrics Interventional Radiology including fine needle biopsies, pain control and drainage procedures Ingenia 3T MRI OPG Phase two services will be DEXA Dedicated Women’s Clinic Digital Mammography, including localisation and sterotaxis Breast MRI And Phase Three will offer

nuclear medicine services. Clinical Director Dr Bob Marshall has been providing specialist services in Radiology in the Port Macquarie area for the past 15 years, most recently as the Managing Radiologist at the Port Macquarie Base Hospital and the Clinical Director for Mid North Coast Diagnostic Imaging. Dr Marshall said he was excited to be expanding services in a new environment and reminded GPs about the practice’s commitment to doctor education programs. “We offer GP Continuing Professional Development through North Coast Medicare Local, Medical Student training through UNSW Rural Clinical School. “We are committed to providing both social and educational evenings for doctors and allied health professionals to share our expertise and experiences,” he said.

Smoke Alarms for the Hearing Impaired (203) The law insists that every home must have a working smoke alarm, but what if you can’t hear it? A standard smoke alarm won’t be any use to people who are severely or profoundly deaf, but studies show that you are twice as likely to die in a house fire if you cannot hear a standard smoke alarm. For this reason, the NSW Smoke Alarm Subsidy Scheme (SASS) aims to ensure that

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anyone living in New South Wales who is deaf, deafblind or hard of hearing can access special smoke alarms at a subsidised price of $50, or free in cases of need. If your clients or patients are deaf, deafblind or profoundly deaf, please communicate with them to find out if they know about the SASS program. There is online information available in Auslan and English about the program and how to

apply for a subsidy; it’s at the Deaf Society of NSW website and there’s also a DVD version of the information available. Contact: Smoke Alarm Subsidy Scheme Project Coordinator, The Deaf Society of NSW, TTY(02) 8833 3691, Ph: (02) 8833 3600, Fax: (02) 8833 3699. Email: smokealarms@deafsociety.com; and http://deafsocietynsw.org.au/smokealarms

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Money printing – what next, who pays? The world’s central banks seemed to have saved the day. When the entire economic structure of the developed world looked as though it would implode under the weight of debt, the central bankers started the printing presses. As a result, vast volumes of cash flooded the markets in an unprecedented deluge and prevented collapse. The money, like oil in an old machine, kept the wheels turning. We need to tip our hats.Yeah, sure, many countries are in deep recession, huge numbers are unemployed and many good businesses have gone broke. But it could have been a lot worse – another great depression perhaps. So is this an unadulterated victory or is there a downside? Make no mistake. We are witnessing a huge experiment that has never been tried before. The stakes are high. The world economy depends on the money printing strategy being successful. But it could go horribly wrong. The biggest experiment is in Japan where the plan is to double the money supply in just a few months, push inflation to two per cent a year, revive the sluggish economy and push down the value of the Yen. The actions of Japan dwarf anything that has so far happened in the US or Europe but their significance has largely gone underreported. Japan has huge problems including an aging, declining population, the biggest public debt by far, 17 years of deflation and difficult structural problems. Japan hasn’t grown for 20 years and the policy makers are desperate. If this new strategy works, then the US and Europe are likely to follow Japan’s lead with even larger doses of money printing. If it doesn’t, and there are plenty of reasons why it may not, then Japan could implode. For example, the Japanese Government has debt amount-

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We are witnessing a bold experiment that could go terribly wrong. ing to 240 per cent of its GDP. It’s financed by bonds that pay interest of around 0.3 per cent a year. Will loyal Japanese savers continue to be happy financing this debt if inflation rises to two per cent - giving them a loss? A rise in bond rates would probably bankrupt a Government that is already paying out half its revenue in debt servicing. An economic meltdown of the world’s third largest economy is a vastly different proposition to the failure of a Cyprus, Greece or even Spain. In addition, the actions of the central banks look like sparking a currency war. As the Yen and the US dollar fall, the competitive positions of China, South Korea, Taiwan, Australia, Brazil, Canada and other Asian countries are significantly eroded. What will they do? Will they retaliate? The answer is we don’t know. Apart from these terrifying scenarios, there are two other issues we should be concerned about. First, how does the world economy wean itself off the flood of new cash that is pouring in every month? Secondly, what happens after the printing presses stop? Will someone have to pay? If so – who? Now we all know that printing money does not create wealth. There is only a limited amount of goods and services produced in an economy. Printing money doesn’t change that. Any economist will tell you that in “normal” times (in an economy that is almost fully employed) the result will be inflation of some sort. It could

Economy

David Tomlinson

be oil, bread, or asset prices such as shares and housing. So far, most of the action has been in asset prices – shares, bonds and, in the case of the US, rising house prices as well. Sure, the central banks expected this, but they are hoping that higher asset prices will change consumer and business psychology. These groups hopefully will become more confident, stop hoarding their cash and get out there to spend and invest. So far the strategy has had only a marginal effect - and so the money printing continues. But as we have seen of late, the share and bond markets across the world are watching closely for a signal that the money printing will end. After all it can’t go on forever. An end to printing will be seen as a sign that interest rates have bottomed and may start going up. This will make both bonds and shares look extremely expensive and there may be a rush of the exit. So how well will this transition be managed? We don’t know, but there is one old and tried option that may be used. As the real economy starts picking up, the money printing could just continue. This would be inflationary, but it would ease the transition problem, boost consumer spending (buy now, before the price goes up again) and help governments with their debt problems. A new inflation target of, say seven per cent, would reduce the real value of existing government debt by 50 per cent in just six years. Very, very tempting. The losers from higher inflation will be the savers, retirees, those on fixed incomes and the poor. Was it ever thus? And if it leads to another asset bubble boom, there will be another collapse. And like 2008, those who pay will be the army of unemployed, the 60 per cent of young people in Europe without a job, the elderly who have had their pensions cut and the businesses that have gone broke.

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Wound Management:

Compression therapy is not a crepe bandage pulled tight By Jan Rice Chair, Australian Wound Management Association (AWMA) Education & Professional Development Subcommittee

Compression therapy is a necessary requirement for some of our patients because peripheral oedema impacts on the function of the skin, resulting in poor healing and skin breakdown. First and foremost, we must determine the cause/s of the oedema: Dependency due to immobility Poor walking techniques Venous hypertension with consequent chronic venous insufficiency (CVI) Cardiac related failure/ renal failure Hypoalbuminaemia Medication related oedema Lymphoedema Identifying the cause and underlying reason/s for any wound is the first step in the healing process. Next is to address all the known factors influencing healing.

What is CVI?

The venous system consists of three systems, four pumps and effective breathing. The three systems include the deep system, the superficial system and the perforators. The deep system is a high pressure system, the superficial a low pressure system; to keep these two from ‘swirling’ together the perforators and their valves control the flow and regulate the pressure.

What predisposes someone to CVI?

The new venous leg ulcer guidelines available from www.awma. com.au inform us that patients may be at greater risk of having CVI if they have a history of Confirmed venous dis32

Jan Rice

ease by venous duplex scan Past history of DVT, phlebitis, pulmonary embolism Obesity Family history of venous problems Trauma or surgery to legs Decreased calf muscle pump Occupations of prolonged sitting or prolonged standing Multiple pregnancies There are specific characteristics that help a clinician to identify a venous ulcer apart from the history above. These are “Brawny” oedema Haemosiderin staining in the gaiter region (reddish brown pigmentation) Lipodermatosclerosis (LPD) Evidence of previous healed ulcers Dilated or torturous superficial veins Atrophie Blanche Eczema and dry scaly skin Altered leg shapeinverted “champagne bottle” Ankle flare—broken capillaries in the foot and ankle region Ulcer is usually located on the medial or lateral aspect of the gaiter region Ulcer has irregular edges

Specific characteristics can help identify a venous ulcer.

Ulcer is quite superficial and predominately viable tissue Pain is variable but often tolerable especially when leg elevated Leg is often itchy and hot at night Having taken a history and reviewed the ulcer characteristics, what is the next step? Venous leg ulcers require compression therapy to reduce oedema and support valvular function. Compression therapy increases the hydrostatic pressure of the

extra-vascular tissues, reduces the lumen of the vein and also reduces the blood volume by 62 per cent in the standing position. Additionally it forces fluid into both the venous and lymphatic system, thus reducing oedema and facilitates the action of the calf muscle pump.

How do we achieve compression?

For compression to be effective it has to offer higher pressure at the ankle distally and lower towards the knee proximally. A bandage

Continued page 34

Compression subsidy sought On the back of a national study by KPMG, the Australian Wound Management Association (AWMA) has strengthened its push for the Federal government to subsidise compression therapy for venous leg ulcer care. The report, An economic evaluation of compression therapy for venous leg ulcers, estimated that up to $166 million per year could be saved if all eligible patients with VLUs could access compression bandages and stockings. “At present, the barrier to best-practice use of compression items is their cost, which most patients must pay for personally,” AWMA national

president Dr Bill McGuiness, told HealthSpeak. “VLU patients tend to be elderly people of limited means, and the majority is not receiving this recommended care. Most wounds managed with compression heal within the benchmark time of 12 weeks, nearly twice as quickly as otherwise.” Around 42,600 Australians aged over 60 years have at least one VLU at any time. Hospital admission is required for the 11% of patients not receiving compression, at a cost of up to $9,380 per separation. The KPMG report is available for download at www. awma.com.au

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Locums at large

Light Airs

daughter who was adamant about having ‘the bar’ and suggested, ‘Why not put a reminder in your phone for the pill?’ In desperation I went out to seek advice from the practice nurse who suggested, ‘Tell her it’s a great big thick needle and really hurts.’ This tactic made no difference to the set of the adolescent mouth. ‘I’m not allowed to stay at his place anymore until I get the bar’ she finally blurted out. There it was, the boyfriend’s mother setting the bar. In my couple of weeks I of locuming I discovered a whole different world, medical nomads ‘I want the bar in me arm.’ She was 15 years old, according to the unfamiliar computer program on my desk. Examination revealed a plain dumpy girl with a determined mouth. A stranger in a strange land, It took me a few seconds to work out that ‘the bar’ must be local idiom for the hormone contraceptive implant. It had been some time since I had inserted one of these disappointing devices and I wasn’t keen to sow trouble for myself, or the patient for that matter during my shortterm stay. Here I was on a distant shore of the Apple Isle conducting an experiment in the locum lifestyle. Accommodation? The deluxe self-contained apartment of our old motel held some ‘50s charm, slightly outweighed by dire warnings about exchanging our old towels for theirs. Their 3-star rating would be compromised if an inspector discovered towels of different colours. My companion, a writer behind deadline, seemed quite happy to see me out the door HealthSpeak

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for an unaccustomed 0830 start. I was working for an agency, something not previously attempted. The modern corporate clinic reminded me of a spaceship which had landed in an oldfashioned coastal town to beam in the locals who appeared quite alienated by the bank of receptionists riveted to their computers. Returning from that daydream which patients could mistake for deep thought, I hedged, ‘Do your parents know about this?’ ‘Mum will be along soon.’ Sure enough mum came in just in time for me to establish that my patient was newly engaged in a sexual relationship conducted at her boyfriend’s house. ‘What about the pill?’ I parried as we talked about how young she was for such strong hormonal intervention on her still-forming body. ‘Tried that,’ she sulked. ‘Any problems?’ ‘No. I just forget to take it,’ I reflected this might explain the lack of adverse effects. The mother seemed to understand that better than the

The last regular doctor was much missed and at only 48, may have been loved to death who move around from place to place, having time off in between. They come from all nations, old and young, male and female, single and accompanied. During my stay the other doctors were a senior Scot on his own, a mother of four children whose husband was homeschooling and a Chinese man waiting for his family who said the motel did not meet Singapore standards. The last regular doctor was much missed and at only 48, may have been loved to death. Another, whose room I occupied was on extended sick leave, location unknown. A few wistful family relics around the

David Miller

room gave hope that one day she might return. In a mining backwater near the town of St Henri (not its real name but borrowed from the label of an excellent red that Dr Chris Ingall might have eulogised in his informative column, ‘Wine and good health’), one of these locums had nested, to the delight of the inhabitants. ‘His name is Cyril.’ The museum curator informed me that he was a 35-year old Burmese who wanted to blend in, so anglicised his name. ‘Dr Cyril has a dry humour, doesn’t say much.’ The population mainly appeared to be elderly Caucasian, curious in light of the socio-medical myth that ready access to tertiary care is a prime consideration in retiree habitat selection. All medical emergencies were transferred by air, narrow roads to the city were twisted and populated by nocturnal wildlife. The economy was depressed. Many shuttered houses were owned by mainland bargain hunters. So what of the locuming lifestyle? There are definite benefits, no worries about getting paid, car and accommodation included and a chance to explore the region after work. For the patients who have to keep changing doctors it’s quite difficult, and many asked, ‘Are you staying?’ A down side for the doctor too, this lack of continuity. One of my jobs was to go through test results from former doctors. I wonder too about some skin lesions I removed and hope that my successor did the right thing. I also would like to know how my patient managed her boyfriend’s mother. Maybe next summer I’ll go back and find out.

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Binge listening is damaging our youth Australian Hearing in Coffs Harbour is warning young people and parents that regular exposure to loud music or ‘binge listening’ can cause permanent hearing damage and loss. “Although hearing problems are normally associated with ageing, our youth will need hearing aids earlier in life if they continue to damage their hearing by listening to music at dangerous volumes,” says Karina Morrison, Manager at Australian Hearing. Research by Australian Hearing’s National Acoustic Laboratories shows that it is not just mobile devices that can cause damage to hearing. Attending nightclubs, pubs and live concerts, can also impact on hearing. The research shows that many young people don’t realise that once their hearing is damaged, it can’t be restored. And even more alarmingly, while youth are aware of the risk of loud noise to hearing they are not changing their behaviours. “The very sad fact is that noise induced hearing loss is prevent-

From page 32 put on a normal shaped leg will achieve this graduation if the tension of the fabric is maintained for the entire length of the lower leg. Unfortunately, some clinicians pull the bandage tighter as they reach the knee as they can see they are about to run out of bandage. Clearly, this is incorrect. The key is to know what compression is required and what compression levels can be achieved, but before applying compression, to re-check that the diagnosis is venous. Pulses are palpable and there are no indicators of arterial disease or cardiac failure. Crepe bandages applied to an oedemaotous limb will have to be re-applied every 30 minutes in order to deliver any resistance and offer graduated compression: hardly practical, and moreover they fall down if they initially ‘push’ the fluid out of the leg. Elastic bandages, for example Surepress, Setopress Tensopress, achieve high working compression and high resting compres34

able. If you listen to your iPod at 100% volume, the maximum safe amount you could listen each day is only five minutes. After that, long term hearing damage can occur,” said Karina. She said by simply turning down an iPod to 80% volume it’s possible to listen safely for 90 minutes . “Just a small change can help avoid a permanent hearing disability,” Karina added Suggested measures:

As part of Youth Week celebrations in April, Australian Hearing

sion – they ‘squeeze’ the leg day and night – walking or not walking. Being elastic they will re-conform to their original length as the oedema subsides. Inelastic bandages, for example Comprilan, Lastolan, Tensolan, work more by resistance and are applied firmly. As the calf muscle contracts and swells it pushes against the firm bandage and aids venous return. These have a high working pressure and a low resting pressure so tend to be more tolerated by patients. However, these also require frequent application. The difference is that elastic bandage application requires considerable skill – hence, appropriate training - and inelastic bandages are much easier to apply. Multi-layer, multi component bandage systems (e.g. Profore, Coban 2, Veno 4) combine elastic and inelastic properties, resulting in an overall inelastic system. Some of these also require great skill to apply. In my experience, most practices are unaware of the many

bandages available, with the most commonly used being the straight elasticated tubular bandage that can be used to achieve graduated compression. Evidence shows that using the correct size for the limb from toes to knee, then a second layer from toes to two-thirds of the lower leg, and finally a third layer from toes to one-third the lower leg can be very effective in managing oedema when backed up with good education and sound basic wound care. So what next, once the ulcer has been healed (a benchmark of time of 12 weeks applies to most venous leg ulcers deemed suitable for compression therapy)? Perhaps you have referred the patient to a vascular surgeon for a venous duplex scan and correction of the leaking valves. This may not always be a suitable option, especially if the patient has already had several vein procedures. So maintenance of venous valvular support must be continued. This is often achieved using knee high graduated compression garments in conjunction

Turn down the volume on their personal stereo system (Phones, iPods, MP3 or stereo) Move away from the speaker or sound source at concerts or clubs and take breaks Protect their ears with ear plugs or ear muffs

delivered this message directly to hundreds of youth at the “Check Your Head” Music Festival in Coffs Harbour. Using ‘Kylie’, Australian Hearing’s Acoustic Mannequin, young people were able to ‘sound check’ their own iPods, Phones and MP3 players and see whether they were putting their ears at risk and how to reduce future damage. To maximise the reach of this important message, the Coffs Harbour Australian Hearing team plan to take Kylie, Australian Hearing’s Acoustic Mannequin on tour with a young audiologist, visiting regional education campuses, including high schools, TAFE and universities. Young people can ‘sound check’ their own iPods, Phones and MP3 players, see whether they were putting their ears at risk and learn how to reduce future damage Australian Hearing provides free hearing services for people up to the age of 26. Call 131 797 or visit hearing.com.au.

with walking, ankle exercises and leg elevation when not walking. There are many brands of compression socks and stockings available, and when making a selection the patient will require guidance on the level of compression, as well as assessment for their ability to put the garment on and off.

In summary Make the correct diagnosis Reconfirm your diagnosis Select a compression system and receive education on correct application technique Continue to monitor oedema When ulcer is healed, recommend ongoing compression therapy in the form of a sock or stocking Contact the author at: j.rice@ latrobe.edu.au

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Books with Robin Robin Osborne

High Sobriety Jill Stark Scribe $29.95 The day I started Jill Stark’s insightful account of Australia’s ‘love affair with alcohol’ a report appeared in the national press headed, “Cost of boozing”. Despite the enormous sum involved, the story was merely an inside news brief – a few pages later came the big spreads for liquor barn specials – saying an Australian Institute of Criminology/Griffith University study found that alcohol-related problems cost society around $14.4 billion, twice what alcohol sales contributed in tax revenue. The faces behind such figures are what Ms Stark set out to reveal when, after a torrid New Year’s Eve 2010, she embarked on, as the sub-title puts it, “My Year Without Booze”. Not the least of these drinkers was herself: as well as being a health reporter for The Age, noted for documenting the consequences of risky drinking, she was regularly getting drunk on weekends. “I’m the binge-drinking health reporter…I’ve even won awards for my ‘Alcohol Timebomb’ series… but it hasn’t deterred me… At the 2010 staff Christmas bash, I won the inaugural Jill Stark Drinking Award.” Hangovers became second nature, as did turning up for work under-slept, often unable to recall, until reminded by colleagues, how much ‘fun’ she’d been the previous night. Struggling through January 1, 2011 she felt a “complete writeoff ” but was mindful that many were in the same boat. “I’m surrounded by people who drink in exactly the same way. I grew up in a country devoted to boozing, and I moved

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to a nation similarly enamoured with it. Just like Scotland, Australia’s default bonding-ritual is drinking. We use it to celebrate, commiserate, and commemorate… “Drinking is how we farewell the dead and welcome the newly arrived; we drink at the footy, we drink with workmates, we drink on public holidays and on weekends. Booze is the nation’s social lifeblood.” With a growing awareness that her drinking practices needed to change, despite fearing how ‘boring’ a life without alcohol might be, the author visited Hello Sunday Morning, an online network for people resolved to cut out alcohol for 3 to12 months and blog about their experiences. She had written about them for one of her stories on the harms of alcohol. She resolved to commit to three months of sobriety – “It’s

I’m the binge-drinking health reporter, I’ve even won awards. less than 1 per cent of my life so far. What do I have to lose – other than horrendous hangovers, a beer belly, and the gaping hole in my pocket?” As it happened, the pledge would continue all year, and lead to one of the most valuable books on the subject yet published in Australia. In the course of her sobriety Ms Stark went to parties, bars, weddings, even the funeral of a young relative in Scotland. She had fun and got fit. She visited hospitals, Odyssey House and youth centres, met with the Cancer Council, addiction experts and medicos, had an MRI scan to see if her brain was damaged by drinking (luckily, she appears to have survived).

“I know now that alcohol does not define me. Getting drunk does not make me more Scottish or Australian, nor does it make me a better daughter, friend, aunty, or sister. I don’t need a beer in my hand to be accepted as a journalist, a writer, or a footy fan. “I stayed sober for more than a year, and I was still all of those things. Without booze, I loved, laughed, and lost. Life did not stop. But it certainly did change.” The author examines the society in which alcohol flourishes – Woolworths and Coles discounting petrol prices for alcohol shoppers, convenience stores seeking liquor licences, and the massive sponsorships of professional sport: “Alcohol is the lifeblood of every major sport in this country… Sporting heroes have become mobile billboards for alcohol companies.” After twelve months, she didn’t even feel like a drink on New Year’s Eve and thereafter has imbibed lightly, mindful of the neurologist’s advice that prompted the MRI. But her wider concerns remain. “It’s tough to convince Aussies to take a break from drinking when alcohol is so ubiquitous – used to commemorate our fallen diggers, backup our sporting heroes, and sell us the notion that it can help us to make friends and find love. “As rewarding as my year without alcohol has been, swimming against the tide has been bloody hard, and at times exhausting. It could be even harder for the next generation of drinkers. “As long as laying off the booze leads to claims that you’re a boring, un-Australian loser in an environment set up to convince you alcohol makes you cool and socially functional, young people will continue to get pissed for confidence, comfort and belonging.” Hope alone will not avert this fate. HealthSpeak contributor Robin Osborne is a media and communications adviser, formerly with NT Health and NSW North Coast Health.

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Group therapy reduces Anxiety Disorder A QUT study suggests that group therapy for Generalised Anxiety Disorder or GAD, over a few months, reduces worry, trait anxiety and depressive symptoms. Those with Generalised Anxiety Disorder find their enjoyment of everyday life inhibited by excessive and uncontrollable worry and whose treatment presents a significant cost to the healthcare system. Dr Emma Burt-Hill from QUT’s School of Psychology and Counselling said GAD was very common in the general community and also occurred with a number of other conditions such as mood, substance use and personality disorders, and anxiety disorders like panic disorder with agoraphobia, and social and simple phobias. “The results show that group

therapy for all methods over nine or 14-weeks reduced worry, trait anxiety, and depressive symptoms. And the good news is, after six months we found that participants had maintained those gains. “This suggests that therapy for GAD can be conducted in groups thereby enabling more people to receive help and cutting healthcare costs. GAD is a

New Anti-Smoking Ad Campaign

The Federal Government has embarked on a new campaign of advertising across all media to help Australians stop smoking for good. The Stop before the Suffering Starts campaign highlights the immense suffering people and their families can go through as a consequence of smoking-related diseases. Launching the campaign, Federal Health Minister Tanya Plibersek said smoking was known to cause harm to nearly every organ and system of the body. “Conditions caused by smoking can result in not just death, but in living for years of suffering with disabling health problems. Tobacco

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smoking is still the single largest cause of preventable premature death and disease in Australia – it kills 15,000 Australians each year and costs the economy $31.5 billion. “We want to let people know the health dangers associated with smoking and help to prevent hundreds of thousands of Australians from suffering as a result of smoking related illnesses,” the Minister said. The advertising is part of the Government’s strategy to reduce smoking rates to 10% by 2018. Other measures include our world first plain packaging legislation and putting smoking replacement therapies onto the PBS.

chronic and fluctuating condition that affects many people's daily living,” Dr Burt-Hill said. “It can be costly for the health system as it is difficult to treat,” she added. In order to find viable and cost-effective alternatives to oneon-one therapy, Dr Burt-Hill studied the efficacy and durability of three different forms of psychotherapy for treating GAD delivered in groups rather than individually. “I carried out two studies of group therapy for nine weeks and 14 weeks duration with a follow-up six months after the end of therapy to gauge the lasting effects,” Ms Dr Burt-Hill said. “The first study compared the results of nearly 30 individuals from three groups who under-

took nine weeks of either Cognitive Behaviour Therapy (CBT), Supportive-Expressive Psychodynamic Therapy (SE PDT) or Emotion-Focused Therapy (EFT). A second study had two groups undertake 14 weeks of either CBT or SE PDT.” “The results show that group therapy for all methods over nine or 14-weeks reduced worry, trait anxiety, and depressive symptoms. And the good news is, after six months we found that participants had maintained those gains. “This suggests that therapy for GAD can be conducted in groups thereby enabling more people to receive help and cutting healthcare costs.” Dr Burt-Hill said the length of therapy was an important factor. “The 14-week course of CBT was more effective at producing long-lasting beneficial outcomes than the nine-week CBT,” she said. “A significant finding at the six-month follow-up was that those who had taken part in the 14 weeks of CBT had a 15 per cent higher benefit for recovery than 14 weeks of supportiveexpressive psychodynamic therapy.”

One vaccine protects against four diseases From July 1, Australian children will need just one needle at 18 months to be fully protected from mumps, measles, rubella and chickenpox. The new MMRV vaccine replaces both the MMR vaccine currently given to four year olds and the varicella vaccine for chickenpox given to 18 month old children. No script is needed to get the vaccine, simply make an appointment with your GP or immunisation clinic. The new vaccine coincides with the release of the 10th edition of the Austrailan Immunisation Handbook which introduces new vaccines, contains updated recommendations on vaccine use. Launching the handbook,

the Minister for Health, Tanya Plibersek, said the new handbook was an important tool to inform parents. A summary table provides recommendations for vaccines during pregnancy. The Handbook also includes important information about catch-up vaccination schedules, vaccination for special risk groups, vaccination for groups with special requirements, and vaccination for international travel. There is also information about managing rabies and Australian bat lyssavirus exposures. For more information or to order a copy of the handbook, visit; http://www.immunise.health.gov. au/internet/immunise/publishing. nsf/Content/Handbook10-home

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Wine and good health Chris Ingall

The question of taste I often wonder why a riesling tastes, well, like a riesling! And a pinot noir runs true to its taste, such that it is difficult to mistake one for another. (That is, if you drink enough). And why this is so the world over, so a syrah in France tastes very like a shiraz from down under, albeit with its terroir (regional characteristics) morphing it slightly. I have banged on about the fruit spectrum being the grape’s signature, but in fact there may be more to it. So to test this theory (and give you a quick outline of some wines you might like to taste) I tasted wines which share grapes from here and there. Like all of us, wine varietals are immigrants to this country, and, climate change notwithstanding, are finding their place in our vast land. Expect the varietals from the south of Europe to flourish here as the temperature edges upwards. I chose excellent examples of grape varieties grown relatively recently here in Australia, which have been grown in their ‘home’ countries for centuries. A tempranillo from the Limestone Coast was a knockout, excellent savoury notes and spice just great for a pasta dish, the maker Running With Bulls Tempranillo 2011, selling for $16.75*. I was lucky to have a bottle of Marques De Tezona Tempranillo 2010 from Spain to match it, presently affordable at $9* and a touch drier, still HealthSpeak

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wonderful with food. Of course a 2010 Pinot from Martinborough was delicious, this time a Hidden Label* at $18, up against a village Burgundy from Leflave costing $25, from Dan Murphy’s. The ‘local’ wine (well, from across the dutch) showed better structure and will age, the French wine sweeter, but both were bargains and would go beautifully with any lighter red meat meal or even

Expect the varietals from the south of Europe to flourish here as temperatures edge upwards. a strongly flavoured pasta. A 2010 (great vintage, see below) Metala shiraz cabernet blend from Langhorne Creek*, at just $13 was delicious, and while nowhere else in the world blends these two grapes, I compared it to a Rhone syrah-grenache blend from the Cotes De Rhone (M. Chapoutier Côtes-du-Rhône Grenache Syrah 2010) which was just as attractive, but with some sour cherry notes and spice to give it more interest (Dan Murphys again, $14.25). The whites were a crazier comparison, but interesting nonetheless. A 1975 St Croix du Monde from the Bordeaux region made from semillon and sauvignon blanc (and a little muscadelle) was still alive and kicking, it’s cold tea colour rimmed with green and with great legs, body and mouth feel, while a 1998 Houghton’s White Burgundy, again a blend including semillon, with verdelho and chenin blanc this time, was similarly racy, still youthful and with plenty of acid. Semillon has wonderful longevity, and when mixed with chenin blanc in particular will last for decades. Add screw caps and you can manage this even in a non air-conditioned cellar. I bought both wines for less than $10 a bottle, but even now you can pick up this Houghton’s blend (now

called Houghton’s Classic) for little over $8*, and the French wine for perhaps $20 to 30. The Houghton’s wine is re-released as a museum classic and will reward you with marmalade, nut, citrus zest and a lovely creamy palate. Ah!, the benefits of a cellar even for inexpensive wines. So, what apart from the sugars makes these wines recognisable? My answer is that there are signature acids, particularly tartaric (skins), malic and citric acids which define (and identify) the wine we drink just as surely as grape sugars. So we recognise semillon for example as much by its spectrum of these acids as we do by the apple and lemon tastes we encounter. Or it could be said the combination of sugars and acids define the fruit components, but more of this in another column. Oh, and by the way dear reader, I receive no kickbacks from any supplier, but am eager for you to find the most affordable and delicious wines available at the moment. All wines with* are from Kemenys.

Wine Tip To enjoy the morning after, take the number of decades you have lived and add one, and that is the lowest age of the wine you should drink, red or white.

Cellar Tip The 2010 vintage for red wines from the east of Australia was an absolute cracker and we lucky punters are in for a treat if we can keep our hands off them for at least seven years. Shiraz from the Barossa, cabernet from Coonawarra and red blends from the Clare, Langhorne Creek and McLaren Vale are all standouts. Little wonder the 2010 Penfolds reds made such a fuss. And for riesling lovers 2012 was a standout in the Clare and Eden valleys, and even the Adelaide Hills.

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Diary

September 13 to 15 General Practitioner Conference and Exhibition (GPCE) To be held at the Brisbane Convention Centre The launch of the Brisbane GPCE follows on from the success of the established GPCE events in Sydney and Melbourne. The Brisbane GPCE scientific program will be accredited by the RACGP and will focus on key primary healthcare topics with a specific bias towards Queensland-specific issues and themes. Seminars run for 1 hour, are didactic presentations and can hold from 60 to 200 delegates. Workshops are for smaller groups of up to 25 and are interactive, including the use of case studies, role plays or practical hands-on sessions. The Brisbane GPCE will be co-located with the Brisbane PNCE conference. Contact: vanessa.hilliard@reedmedicaleducation.com.au September 13 to 15 Australian Lifestyle Medicine Conference To be held in Manly, Sydney Speakers include Dr Rosemary Stanton “Good nutrition and a

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October 1 OSSANZ 2013: 24th Annual Scientific Conference of the Obesity Surgery Society of Australia and NZ To be held on the Gold Coast Contact: ossanz@thinkbusinessevents.com.au October 17-19 GP13: The Conference for General Practice of the Royal Australian College of General Practice To be held at the Darwin Convention Centre The Academic Session, including the RACGP Fellowship and Awards Ceremony, will be held on Wednesday 16 October 2013. Contact: racgp@racgp.org.au

2

The Egyptian plover is a North African bird that picks the teeth of which animal?

12

What was Sir Donald Bradman’s batting average?

13

3

With which country did Japan go to war in 1904?

In Cluedo, what colour is the playing piece for Mrs Peacock?

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4

The term ‘bunny boiler’ was derived from Glenn Close’s deranged character in the film Fatal Attraction, true or false?

The musical West Side Story was based on which Shakespeare play?

15

Who was Superman’s first girlfriend?

16

What does ISBN stand for?

17

Which fashion designer designed the famous conical bra for Madonna?

What Jane Austen novel has a main character named Fanny Price?

18

What is the alcoholic ingredient in a Snowball cocktail?

Who wrote the book ‘A Brief History of Time’?

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Which food item takes its name from the French for ‘twice cooked’?

20

How many ‘C’s’ denote the value of a diamond and what are they?

21

In winning his first Golden Globe Award, who thanked every American who had not sued him?

5

6

7

What type of creature is a tuatara? Is it a bird, fish, reptile or insect?

8

What is the name of the pet dog in The Simpsons?

9

In animation, who was captain of the Black Pig?

10

How often is the human stomach lining replaced? Every three days, three months or three years ?

Geronimo was chief of which North American Indian tribe?

October 27 to 30 15th World Conference on Lung Cancer To be held in Sydney Contact: wclc2013@icsevents. com

November November 13-16 National Primary Health Care Conference 2013 To be held at the Gold Coast Convention and Exhibition Centre Sponsorship opportunities: please contact Trisha Wong, Manager Marketing and Health Promotion by phoning: 02 6228 0835 or email: twong@amlalliance.com.au Exhibition opportunities: please contact Nicole Shepherd, Senior Events Coordinator by phoning: 02 6228 0846 or email: nshepherd@amlalliance.com.au

HealthSpeak

Answers:

September

October

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Standard Book Number 17. Mansfield Park 18. Stephen Hawking 19. Biscuit 20. Four – cut, colour, clarity and carat 21. Sacha Baron Cohen

August 19 Eating Disorders – Mental Health Professionals Network, Byron Shire Network Meeting To be held at Byron Bay RSL from 6pm to 9pm Expert panel with Dr Mim Weber, Deanna Bowen and Dr Susan Joyce Light refreshments will be provided Please RSVP for catering purposes to Geoff Ward at: g.ward@mhpn. org.au

Which of the Teletubbies shares its name with an Italian river?

Helper 9. Captain Pugwash 10. Three days 11. Apache 12. 99.94 13. Blue 14. Romeo and Juliet 15. Linda Lang (Supergirl’s real identity) 16. International

August

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1. PO (river in northern Italy) The crocodile Russia True A reptile (lizard) Jean-Paul Gaultier Advocaat Santa’s Little

July 16 Chronic Kidney Disease & Diabetes For Practice Nurses – workshop To be held in Lismore at Invercauld House from 6pm Presented by Nurse Practitioner Graeme Turner Meal provided Please RSVP by July 19 to Graeme at: Graeme turner@ncahs.health. nsw.gov.au

healthy environment, how the two are related.” Guy Leech (former Ironman champion) on Fit, Fifty and far from F****ed”. Session themes include: Processes in Lifestyle Medicine, Sex and Lifestyle, Obesity and Weight Control, Exercise Management for Chronic Disease and Disability, Is Alcohol a Good or a Bad Lifestyle Choice?, Teeth and Lifestyle, The role of Personal Trainers in Lifestyle Medicine, Indigenous Lifestyle Medicine and lots more. To register, go to: https://lifestylemedicine.com.au/5th-annualconference

2. 3. 4. 5. 6. 7. 8.

July

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Vacancy for GP VR GP wanted for busy, well-established 12dr family practice + skin clinic. Fully accredited and computerised, mixed billing, rural incentives, FT RN, friendly work atmosphere. No on call required. Please email CV to admin@oceanshoresmedical.com

PATHOLOGICAL WASTE DISPOSAL Container Collection/Exchange

RICHMOND WASTE SERVICES Phone 6621 7431 – 6687 2559 Lismore • Ballina • Casino • Byron

OPEN extended hours MON, TUE, WED & FRI - 8.30am to 7pm Thursday - 8.30am to 9pm SATURDAY - 8.30am to 5pm SUN - 9am-1pm

Goonellabah Pharmacy

Goonellabah Village, Oliver Ave, Phone 6624 2449

Goonellabah Physiotherapy Centre Gabrielle Boyce and Associates 581 Ballina Road, Goonellabah Phone (02) 6625 2888 Open Extended Hours

GP VACANCY BALLINA Family Medical Centre www.ballinamedical.com.au

Seeking a full-time GP, 8-10sessions, M/F &/ or husband /wife team. Assistant with view to Associateship. Five doctor practice, currently 4 male,1 female. Happy workplace, long term loyal staff, supportive environment .Mixed billing. Modern purpose-built surgery, 5 consulting rooms, 2 bed treatment area and minor theatre. Opportunity to practice all aspects of Family Medicine in relaxed North Coast Lifestyle VMO position at Ballina Hospital optional. Well run, efficient practice. Enquiries pm@ballinamedical.com.au or phone 02 6686 3299

Bullinah Aboriginal Health Service Aboriginal Corporation www.bullinahahs.org.au 120 Tamar St, Ballina NSW

more services · quality facilities

•Sports & Orthopaedic Conditions •Treat Spinal Pain with mob/ manipulation and Sarah Key Method •Acupuncture for myofascial pain/ muscle spasm •Gym & Pool rehabilitation •Biomechanical analysis for runners and dancers •Orthotics using Gaitscan Technology •Waterproof casts / braces / splints •Vertigo & Balance Disorders Tony Morley & Emile du Plessis and Associates Physiotherapists MAPA

A/Prof Geoffrey Boyce Neurologist

Lismore & Ballina Free Call 1800 662 125

Practising neurology and neurophysiology in Lismore. Dr Boyce has a full-time neurophysiology technician available to do electroencephalograms with little waiting time. Also nerve conduction studies and electromyography. The practice is Medical Objects friendly and welcomes referrals this way.

GP Vacancy, Tweed PT/FT General Practitioner required for modern, family friendly practice in the Tweed.

Phone the practice on 6621 8245 or email: nrneurol.com.au For more information and links to other sub-specialty groups, view the website at: www.nrneurol.com.au

Semi rural position, F/T Practice Nurse, supportive staff, flexible working arrangements, great patients. Pathology, Chemist, Allied Health. Next to excellent schools and child care centre. No weekends, evenings optional. Excellent remuneration. DWS may apply. Tel 0755905000 or A/H 0429 080 330.

GP required for Kempsey GP Clinic Flexibility; Full-Time or Part-Time work in a rural setting close to beaches. Attractive salary & benefits. Applicant must have basic medical training, & competency in all areas of usual general practice. Fully accredited, new modern practice with nursing support and within a medical complex. Contact Karen Watherston 02 6562 2688 Level One, 35 Belgrave Street KEMPSEY NSW

Seeking a GP VR Full-Time Permanent GP required for a busy modern medical centre in Port Macquarie. Please email your resume to nancy@thegoodshepherd.com.au or call Nancy on (02) 6581 4494 or fax (02) 6581 4481

GP Vacancy – short term contract Monday 24 June to Friday 19 August Minimum 3 days per week & up to 5 days. 9am to 5pm Full practice nurse support staff. email ceo@bullinahahs.org.au or phone 02 6681 5644

New Exercise Physiology Clinic in Alstonville. Specialising in: Chronic Disease Management Lifestyle Modification Falls Prevention. Groups and Individual services.

HealthSpeak is the perfect place to let the north coast health community know about your practice, company, rooms for rent or anything at all! With a readership of around 4,000 and a footprint from the Queensland border to just south of Port Macquarie, your message will get out to GPs, allied health practitioners, pharmacists and those working in the health care community. Display advertising is attractively priced. Simply email the editor to get a copy of our rates at: media@ncml.org.au We look forward to hearing from you.

Rebecca Trim (AEP, MAESSA) Ph 6628 8888

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Care Services

CARE

SERVICES

Healthspeak winter 2013