Newsletter of the Public Health Association of Australia Inc.
Population Health Congress 2015 Report By Carla Gorton, Senoir Public Health Officer, HIV, Viral, Hepatitis and Sexual Health Coordinator
Vol 32, No 11 December 2015
Inside this issue… Population Health Congress 2013 Report 1 Doctors Get Moving on Climate Change 2 Chronic Disease Program Targets Hospital Admissions 3
The Population Health Congress in Hobart was an excellent opportunity to experience the breath and passion of the public health workforc in this country and I was notdisappointed. The plenary sessions each morning were outstanding. Wales’ Chief Medical Officer Dr Ruth Hussey spoke about the Well Being of Future Generations Act which requires all public bodies to consider environment, health and social principles in every decision they make. It certainly set the tone for the discussion over the three days which focused upon sustainable development, empowerment and community engagement and development. The information Ruth presented about the #TheWalesWeWant conversation was a great example of moving from the illness framework to a wellness framework. In a similar vein Dr Alessandro Dimaio from NCD Free and Graeme Innes from the Attitude Foundation also challenged and inspired us to be advocates and address inequalities, again a theme that continued to the final sessions. As a founding member of Cairns Action for Sustainable Transport the Tuesday morning plenary on Healthy Spaces and Places was a real treat. I wrote a whole page of notes from Phillippa HowdenChapman’s “Healthy Cities: How do we know?” talk and can’t wait to read Peter Newman’s new book “The End of Automobile Dependence”.
Big Data to Tackle Big Health Problems 5 Highlights from the 2015 SA Population Health Conference 7 CAPHIA Teaching and Learning Forum in Hobart 8 Local Drug Action Inc
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Primary Health Care Confernce photos 10 Second National Complex Needs Photos 12 Office Bearers
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Welcome to our New Members December 2015
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The Wednesday plenary featured more powerful talks, including: one by Lisa Bero about industry tactics to manipulate public health research; a call to action by James Ward to address endemic rates of sexually transmissible infections in Aboriginal and Torres Strait Islander young people; and Trevor Hancock and Tony Capon both exploring the health of our planet as an underlying precondition for public health. In the E-Health session I learnt a lot more about what does and doesn’t work in social media campaigns. Continued on next page
The Public Health Association of Australia is the major organisation for public health practitioners in Australia with more than 40 health related disciplines represented in its membership. The Association makes a major contribution to health policy in Australia and has branches in every state and territory. Any person who supports the objectives of the Association is invited to join.
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The presentation by Ximena Masgoret from the Cancer Council of NSW about treatment uptake for chronic hepatitis B ignited lots of ideas and tapped into my passion to see improvements in this area. The Environmental Health session addressed the public health impacts of coal seam gas and the paper on the Health Impact Assessment on the Trans-Pacific Partnership agreement highlighted great work being done by the Centre for Health Equity Training Research & Evaluation in NSW. Not wanting to miss a thing I also got along to lunch-time sessions and am proud to see the professional body I am a part of responding to the overarching issue of Climate Change in such a considered and active way.
I believe that Dylan Coleman’s “Using Indigenous Methodologies” presentation would have made an excellent plenary presentation. The points Dylan covered including honouring cultural protocol, taking time to listen, and using storyboards as a knowledge translational tool. She wove these ideas together with theory, Indigenous research methodology, historical information and family stories and was a powerful example of public health advocacy in action. The final session on engagement and advocacy action was a helpful wrap of how to put all of the inspiration into action. The presentation about the range of conferences happening in 2016 and 2017 was also impressive. I made so many connections for my own work here in Far North Queensland with public health practitioners from all around the country and was constantly inspired and re-invigorated by the research and action being undertaken.
There were many stand out presentations on Aboriginal and Torres Strait Islander health, just to mention a few, the Deadly Choices Social Media: Empowering Our People to Create Change by Karen McPhail-Bell and Nathan Appo; the Deadly Ears Program by Renae Anderson and the evaluation of the BEAT IT program by Priscilla Gibson.
Doctors Get Moving on Climate Change By Kristen Pearson, Doctors of the Envrionment Australia
A cool day in October saw 50 doctors, medical students, friends and family hit the ground running as part of the Melbourne Marathon Festival, in support of Doctors for the Environment Australia (DEA). DEA is an independent, self-funded, NGO of medical doctors and students in all Australian States and Territories. We work to prevent and address the health risks caused by damage to our natural environment. Dr John Iser, retired Gastroenterologist and chair of Victorian DEA says “This is the critical decade, so we need to turn around carbon emissions now. In the lead up to the Paris COP21 meeting we have been writing policy, making government submissions, speaking to politicians, educating our peers and publishing in conventional and social media. I want to ensure my actions align with my philosophy so I joined the team in the Melbourne Marathon event. For the same reason I will be taking part in the international People’s Climate March in Melbourne on November 27th. Physicians have a duty to their individual patients but also to promote public health for their community. We need to ensure that future generations have access to the basic human needs of clean water, food security, shelter, fresh air and a safe climate. I’m delighted that other leading medical organisations are promoting the message, such as PHAA;
Dr John Iser and son Peter taking part in the Team DEA run at the MCG
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The Lancet; Australian Medical Association (AMA) and Royal Australian College of Physicians (RACP): The “Doctors for Climate Change” campaign is one such global movement which organisations and individuals can support”. One of three full marathon runners in the team is Dr Liz Peach, a Public Health Registrar. “By staying fit and active, we can reduce our risk of conditions such as obesity, diabetes, heart disease and stroke. We can also reduce our reliance on cars which burn fossil fuels, adding to air pollution and climate change. The vision of Doctors for the Environment Australia is “Healthy People, Healthy Planet” which is surely a message we can all get behind.”
PHAA CEO at climate change March in Canberra
Mick Chapman in NYC after cycling across the American continent
Chronic disease program targets hospital By Helen Hoare - Manager, Primary and Communtiy Care Cooridinator (Brisbane North PHN)
In a major development aimed at reducing potentially avoidable hospitalisations in Brisbane North, patients who present to hospital with chronic complex health conditions will receive extra community support to help them better manage their condition at home.
The introduction of the Staying Healthy, Staying Home program follows a successful trial last year of joint hospital and community chronic disease management arrangements at Redcliffe Hospital, which will continue to be supported under this initiative.
Queensland Health has committed new funding that will extend Brisbane North PHN’s community care coordination services to accept referrals direct from Metro North Hospital and Health Service hospitals and its Community, Indigenous and Sub-acute Services (CISS) unit.
Brisbane North PHN Chief Executive Abbe Anderson said the Staying Healthy, Staying Home program would help more patients with chronic and complex conditions to remain living well at home. “We are very pleased to be in a position to extend our Team Care Coordination services to more people in the Continued on next page
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Brisbane North and Moreton Bay region,” Ms Anderson said. “We have worked closely with hospitals and primary care providers, over many years, to improve health outcomes for patients with chronic conditions. “The Staying Healthy, Staying Home program will help to maintain the connection between patients and their GP, will support patients to live well at home, and will ensure they can access timely intervention in a primary care setting if their symptoms return”, she said. Brisbane North PHN’s Team Care Coordinators are registered nurses, experienced in the community and in general practice, who have a wealth of knowledge about local public, community and private healthcare services. Coordinators first complete a holistic home assessment, which can help GPs and hospital staff to understand the home and lifestyle environment of their patients with chronic and complex medical conditions. They provide recommendations to the patient, their family and GP to assist them to better manage the patient’s care in the community. The National Health Performance Authority found that 1,078 potentially avoidable hospitalisations per 100,000 people were attributed to chronic illnesses in 2011-12, within the Metro North Brisbane catchment area.
This rate was slightly higher than the average for similar metropolitan regions, but more than 30 per cent higher than better performing areas like Fremantle and South Eastern Sydney. For more information about Brisbane North PHN’s care coordination programs, please contact the PHN’s Service Navigation officer on 1800 250 502.
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Big Data To Tackle Big Health Problems By Faye Janice Lim, Erlyn Macarayan and George Stamatescu
Words like big data, data science, data mining and data visualisation are the latest buzzwords around town, but what does “big data” refer to and what does it have to with public health? While the size requirement for “big” datasets is constantly changing (sometimes on a case-by-case basis), the term is used to describe datasets that meet the 3Vs – volume, velocity and variety. In other words, “big” datasets are those with large volumes, which may change rapidly, and sometimes in real-time (velocity) and come in multiple formats, such as images, audio and text (variety). In a world where more and more new data are being generated every (nano-) second, the challenge now lies in storing, analysing and making sense of all of these data. This challenge is especially vital for public health practitioners. Such discussions were at the centre of the recently held Australia’s Group of Eight universities and China’s C9 Big Data Forum, which we had a chance to be part of – thanks to the support of our universities. Against the backdrop of historic Nanjing University, we were treated to a wide array of talks covering many areas of research – from machine learning to pharmacy, architecture to linguistics, and a good dose of public health – all converging on the use of “big data”. Our collective minds were blown when we were shown CAVE2– a data visualisation tool that can be used to follow neurological pathways of the human brain or to explore high-resolution images of our galaxy. Even with advanced super computers like those linked to CAVE2, nothing beats the human brain in recognising patterns. This is why figures showing multiple contacts with healthcare practitioners pre-hospitalisation are more effective than odds ratios in telling policy makers that poor access to healthcare is not the cause of so-called ‘preventable’ hospitalisations. If the audience can visualise your data, they can engage with it and identify patterns themselves, which in turn builds and maintains their interest in your message. From a public health perspective, presenting data in a visually accessible manner can mean the difference between translation into tangible outcomes and being lost in the abyss of academic literature.
These may all sound futuristic and even too optimistic, but with the aid of big data, research projects that may potentially bring these into reality are already underway, such as Arizona’s decsion theatrefor policymaking or other advanced visualization projects. Along with progress in data visualization is advancement in data storage and analytics with the use of specialized software tools such as Hadoop, MapReduce, and more, Gaining the skills to use these tools effectively is no longer just for computer scientists, but also for researchers in other areas as we begin to explore its huge potential to advance our own fields. The Forum showed us that “thinking out-of-the box” is definitely a must-do for innovation. Multi-sectoral collaboration among researchers from different backgrounds has led to very interesting research Alongside the technical challenges are philosophical and ethical challenges. Who owns these data? Even though these data are non-rival goods (meaning that one person’s use of it does not preclude another from using it), how can we ensure that those who can benefit the most from it are not priced out of it? Is privacy even an issue anymore now that so many of us, unwittingly or otherwise, constantly tell the world about ourselves? These are some of the issues we need to think about now or risk jeopardising all the gains that we have already made in this area. Over the course of the Forum, we were shown how big data can be used to develop healthier living environments; identify pre-cursors to motor vehicle accidents; and create standardised measures for assessing healthcare systems globally. We also saw attempts to use novel data sources, like Facebook and Twitter, to identify the moods or habits of a population, or detect influenza epidemics in real-time, more cheaply than with traditional data collection. These are just some of the public health applications of the wealth of data that is already available. While for some areas, there is a long way to go before we can rely on these new data sources alone, the potential is there.
Some of the public health challenges that we face right now are enormous (think climate change, obesity, antibiotic resistance etc.). There is much more that we can do to tap into this vast amount of data that are and Can you imagine a future where we can map every single will continue to be generated in the future. As public stakeholder in all healthcare systems around the world health practitioners, we shouldn’t be left behind but and still be able to pull out data for specific locations will have to be creative and innovative on how we can or groups to help them make better public health tap into and maximise its potential to advance our decisions? Or one whereby healthcare practitioners can field. With a bit of help from colleagues from around study anatomy and physiology without the need for campus, we may be able to help tackle some of these cadavers in a CAVE2-like environment? issues using the data we already have. For emerging researchers like us, the challenge remains on how we can A time when human physiology, from DNA strands to be more knowledgeable and skilful in dealing with these an entire organ, can be dissected virtually and more innovations and how we can be better prepared to deal precisely and where more “personalized medicine” can with “big data”. Are you ready to take on the challenge? take place.
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Highlights from the 2015 SA Population Health Conference: The politics of public health in turbulent times By Jude Hamilton, Student Representitice for Flinders University on the PHAA
There were also prizes awarded to Lucy Farrell, who was awarded the best oral presentation prize, Kerri Coulthard and Casey Nottage for ‘People’s Choice’ presentation, and Bronwyn Wolfaardt received the best poster prize. Well done to everyone who presented their work at the conference.
The South Australian PHAA Branch held their 2015 State Population Health Conference on Saturday October 31st where approximately 120 attendees exchanged their weekend for wisdom. The event began with an interesting and insightful fable from the key note, Dr Felicity-Ann Lewis, who opened the conference. Yes, I did write fable! It was titled ‘Working with the politics… lessons from the coalface’ and highlighted the importance of gathering evidence, and some possible solutions into a simple message. With this simple message, one can successfully educate the public and politicians that public health improvements are in everyone’s best interest. I would like to thank Dr Lewis for sharing her experiences and her wisdom which I found encouraging.
would like to take this opportunity to express my gratitude to the SA PHAA Branch and the organising committee which was a collaboration between the Australasian Faculty of Public Health Medicine, the Australasian Epidemiological Association and the SA PHAA, in particular co – convenors Patricia Carter & Dr Rebecca Tooher, for organising a fantastic program of speakers, posters and panel discussions. It looks like there is a lot of exciting research occurring in the public health field and I can’t wait for next year’s conference! #SApophlth
The plenary panel, chaired by Professor Tony Butler, titled ‘Prison health is public health’ opened my eyes to an important issue to which I previously had been ignorant. Thank you also to the speakers, Emma Miller, Chris Holmwood and Tom Turnbull for their information and discussions into stopping the health consequences of a system which some have described as having a ‘revolving door policy’. With over 20 other speakers presenting their work across the day in sessions from ‘Chronic Disease: Risk Factors & Management’ to ‘Health Promotion Across the Ages’, there was something for everyone. It seemed that a running theme across the day was that using collaboration between all areas was an effective way to achieve public health gains. Also, that advocacy is a fundamental part of a public health practitioner’s role in their community. In these political times, strong advocacy is the only way to ensure public health messages are integrated into policy. Awards presented during the day included: the Kerry Kirke Student Award, which was awarded to Dr Jianjun Xiang whose research showed great quality, originality and benefit to public health. The Primary Health Care Practitioner Award was jointly awarded to Theresa Francis for her tireless work with Aboriginal and Torres Strait Islander communities and to Lyndall Thomas for her work in the state government on chronic disease prevention.
Dr Jianjun Xian awardee of the Kerry Kirke Student Award
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Council of Adademic Public Health Institutions Australia (CAPHIA) Teaching and Learning Forum, Hobart By Joe Hlubucek, Project Manager CAPHIA
CAPHIA is the peak national organisation representing universities that offer undergraduate and/or postgraduate programs in public health and research and community service activity in public health
postgraduate public health education; environment. There were many creative teaching approaches shared about engaging students more effectively, and what rives class attendance. An approach that enabled students to observe health-decision making in practice through examining decisions they themselves make as a student body – described as choosing between ‘medication or my mobile phone’ - was also shared.
• The program covered topical subjects such as •
Teaching and learning innovations, including student engagement
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Public health competencies, including Indigenous public health competencies
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Undergraduate, graduate and postgraduate course experiences
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Student engagement and course evaluation
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International public health initiatives
Another highlight of the Forum was the presentation of the CAPHIA 2015 Awards for:Excellence and Innovation in Public Health Teaching to Dr Kristiann Heesch, The Queensland University of Technology; Excellence and Innovation in Public Health Team Research awarded jointly to the University of Newcastle and the University of Queensland for their work on the Australian Longitudinal Study on Women’s Health, and accepted by Prof Julie Byles and Prof Gita Mishra; PhD Excellence in Public Health to Dr Ashleigh Guillaumier, University of Newcastle; and CAPHIA President’s Award for Humanitarian Contributions through Public Health to Prof Harry Minas, University of Sydney. Two high commendations for public health teaching were also awarded in the individual and early-career categories respectively to Dr Julie Saunders, the University of Western Australia, and to Dr Tinashe Dune, Western Sydney University. The trophies and certificates were presented by Prof Catherine Bennett, CAPHIA President, and the invited keynote speakers. More details are available in the CAPHIA Press Release of 10 September 2015 on the CAPHIA website at www. caphia.com.au This was Prof Bennett’s final year THis was President, and she was thanked by the incoming CAPHIA President, Prof Colleen Fisher, for her guidance and leadership which has contributed to the success of not only the annual forums but CAPHIA as a whole.
A forum highlight was the three invited keynote presentations which prompted a lot of discussion:Using Publications to Improve Public Health Teaching and Learning, Prof Stephen Leeder AO
The feedback from the forum was very positive. It included useful suggestions for future topics for the next forum such as online versus classroom teaching pros and cons; teaching pedagogy; managing student expectations; and workplace-ready graduates.
Increasing Engagement in Teaching and Learning with Audience Response Technology, Prof Philip Baker Engaging students in Public Health – Tips from the West, Prof Jane Hayworth The two day program included a number of workshops to encourage discussion on a range of topics including the benefits and challenges of workplace-based onpostgraduate public health education;
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Local Drug Action Inc By Allanah Patino and Hayley Hawkins, Local Drug Action Inc
Local Drug Action Groupns Inc. works to empower the whole o community to respond to alchol and other drug issues by providing resources and support. LDAGs provide an opportunity their local community. Made up of action to reduce and prevent alchohol and other drug issues by providing resources and support. LDAGs provide an opportunity for people to actively participate in their local community. Made up of volunteers, LDAGs combine to take action to reduce and prevent alcohol and other drug related harm.
Over the two days the kids made new friends, learnt new skills, created a new and safer perception of the skate park, and were shown they did not need alcohol or drugs to have a good time. The first prize for the raffle was $1,000 worth of alcohol. Not only was this an excellent example of community action – it also showcased the process where harmful behaviours / traditions (related to alcohol and other drugs) are challenged and in response, community attitudes shift to a less harmful position. The Kalgoorlie LDAG received an apology from the Western Australian T-Ball Association recognising the harms between harmful position. The Kalgoorlie LDAG received an apology from the Western Australian T-Ball Association recognising the harms betweennking youth sport and alcohol.
Local Drug Action Groups use the fundamental concepts of ‘community development’ by using a ‘grass-roots’, bottom up approach designed to generate community-action activities. LDAG Inc. supports our network of over 50 LDAGs around Western Australia by providing them with the required resources for hundreds of programs, projects and activities held every year by each of our branches. With creativity and innovation, Local Drug Action Groups run activities that aim to; provide factual information regarding alcohol and other drugs from a health and social perspective, deliver prevention focused activities, and monitor and respond to local issues and trends regarding health and social aspects of alcohol and other drug related harms.
For more information or if you’re interested in starting a local drug action group within your local Western Australian community , then please don’t hesitate to contact us either by phone (08 9370 0386 or free call: 1800 LDAG 07) or email (ldaginc@mhc.wa.gov.au) – we are always happy
Here are a few stories of some events that our LDAGs have held; In Wongan Hills, the local LDAG ran a SK8 ST8 day, which included a two day workshop where the youth got to spray paint a skateboard deck with a health promotion message and learn how to use it.
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Photos taken from the National Primary Health Care Conference at the Canberra Convention Centre 2-4 Nov 2015
Guest speaker: Dr Rick Glazier, Institute for Clinical Sciences, Toronto, Canada
PHAA President Heather Yeatman
Health Stalls at NPHC Conference 2015
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Guest Speaker : Archie Clements, Research School of Population Health ANU
PHAA CEO Michael Moore
Royal Flying Doctor’s Ambulance Service Education stall 11
Photos taken from the Second National Complex Needs Conference being held at the Canberra Rex Hotel, Canberra on 17-18 November 2015.
Sue Miers AM: Guest speaker from NOFASD Michael Moore, David Templeman, Julie Tongs and Tom Calma
Keiran Palmer: Guest speaker from the Noffs Foundation Russ Sevior, Nannette Mitchell, Dean Sullivan and Leanna
Michael Smith, Ian Flaherty, Rachel Rowe and Mark Goodhew 12
Bernadette Mitcherson: Guest speaker from the ACT Corrections serivce
The Public Health Association of Australia Inc. wishes to thank the following organisations for their support to the National Primary Health Care Conferennce 2015 being held in Canberra Convention Centre from 2-4 November 2015.
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15th World Congress on Public Health
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voices vision action REGISTER YOUR EXPRESSION OF INTEREST NOW at www.wcph2017.com
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Office Bearers The Board
SIG Convenors
President Heather Yeatman: hyeatman@uow.edu.au Vice President - (Policy) Marion Carey: mariongc@bigpond.com Vice President - (Development) David Templeman: davidtempleman1@live.com Vice President - (Finance) Richard Franklin: richard.franklin@jcu.edu.au Vice President - (Aboriginal & Torres Strait Islander Health) Carmen Parter: carmen.parter@sydney.edu.au SIG Convenors’ representatives Yvonne Luxford: yvonne.luxford@gmail.com Peter Tait: aspetert@bigpond.com Branch Presidents’ representatives Russell McGowan: lazaruss@bigpond.com Gillian Mangan: gillian.mangan@heartfoundation.org.au
Aboriginal & Torres Strait Islander Health Co-convenors Summer Finlay: summermayfinlay@gmail.com Yvonne Luxford: yvonne.luxford@gmail.com Alcohol Mike Daube: M.Daube@curtin.edu.au Julia Stafford: J.Stafford@curtin.edu.au Child Health Co-convenors Colin Macdougall: colin.macdougall@flinders.edu.au Ecology and Environment Peter Tait: aspetert@bigpond.com Evidence, Research & Policy in Complementary Medicine Jon Adams: jon.adams@uts.edu.au Food & Nutrition Co-convenors Julie Woods: j.woods@deakin.edu.au Helen Vidgen: h.vidgen@qut.edu.au Health Promotion Carmel Williams: Carmel.Williams@health.sa.gov.au Immunisation Co-convenors Angela Newbound: Angela.Newbound@yahoo.com Michelle Wills: michjwills@gmail.com Injury Prevention Co-convenors Richard Franklin: richard.franklin@jcu.edu.au Lyndal Bugeja: lyndal.c.bugeja@coronerscourt.vic.gov.au International Health Jaya Earnest: j.earnest@curtin.edu.au Brahm Marjadi: B.Marjadi@uws.edu.au Justice Health Co-convenors Tony Butler: tbutler@nchecr.unsw.edu.au Stuart Kinner: s.kinner@unimelb.edu.au Mental Health Co-convenors Michael Smith: mikejohnsmith@hotmail.com Kristy Sanderson: Kristy.Sanderson@utas.edu.au One Health (Zoonoses) Simon Reid: simon.reid@uq.edu.au Oral Health
ANZJPH Editors Editor in Chief John Lowe: jlowe@usc.edu.au Editors Priscilla Robinson: priscilla.robinson@latrobe.edu.au Anna Ziersch: anna.ziersch@flinders.edu.au Melissa Stoneham: M.Stoneham@curtin.edu.au Bridget Kool:b.kool@auckland.ac.nz Roxanne Bainbridge: roxanne.bainbridge@jcu.edu.au Luke Wolfenden: Luke.Wolfenden@hnehealth.nsw.gov.au Branch Presidents ACT Russell McGowan: lazaruss@bigpond.com NSW Jude Page: judepage1@gmail.com NT Rosalie Schultz: rosalieschultz20a@gmail.com QLD Paul Gardiner: p.gardiner@sph.uq.edu.au SA Narelle Berry: narelle.berry@flinders.edu.au TAS Gillian Mangan: gillian.mangan@heartfoundation.org.au VIC Brian Vandenberg: Brian.Vandenberg@monash.edu WA (Acting) Jillian Abraham: Jillian.Abraham@health.wa.gov.au
Bruce Simmons: simmonsbruce@hotmail.com Political Economy of Health Deborah Gleeson: d.gleeson@latrobe.edu.au Primary Health Care Co-convenors Jacqui Allen: jacqui.allen@deakin.edu.au Gwyn Jolley: gwyn.jolley@flinders.edu.au Women’s Health Co-convenors Catherine Mackenzie: catherine.mackenzie@flinders.edu.au Tinashe Dune: T.Dune@uws.edu.au
Chief Executive Officer Michael Moore: ph (02) 6285 2373 mmoore@phaa.net.au
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Welcome to our new members
December 2015 NEW SOUTH WALES Miss Katrina Cahmpion Ms Tessa Delaney Miss Jessica Wrigley Mrs Moira Dusnmore Ms Sharon Jacobs Mr Simon Wilcox Dr Jane Frawley Mrs Narelle Payne Dr Hermine N Odouri Dr Smtriti Jaiswal Dr Grace Spencer Mr Stuart King SOUTH AUSTRALIA Ms Trudy Gore Mr Alexander Webb Miss Yimei Li Miss Ashleigh Wilson Mr Bien-Aime John-Baptist Murhimanya Mrs Joanne Rayner WESTERN AUSTRALIA Miss Binyan Pang Ms Janice Foster
VICTORIA Ms Amanda Propoch MrDavid Godden Dr Kathryn Backholder Dr Michael Smith
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