Representatives from 28 university Rural Health Clubs gathered in Melbourne recently for the annual council meeting of the National Rural Health Students’ Network.
Their new Chair, David Khoo, reports for Croakey on what matters most to the future leaders of rural health:
Good health should be a given in a country as wealthy as Australia. Yet the statistics tell us otherwise.
Reduced life expectancy, higher rates of chronic disease and preventable hospitalisation are the sum of diminishing returns the further one travels from the capital cities.
There has to be a better way and we believe it starts by ensuring country people have access to the health workforce they need. We need all hands on deck when it comes to improving health in the bush so this is just as much about nursing and allied health as it is about medicine.
For us, as health students, that begins with the creation of more clearly defined rural training pathways for future doctors, nurses, physiotherapists, podiatrists and other allied health professionals.
We feel that requires improved coordination between rural workforce agencies, professional colleges, training providers, universities, local hospital networks and others with a stake in the workforce pipeline.
This is critical if Australia is to foster a diverse, home-grown rural health workforce that provides complete care.
As future health leaders, our steps along the road to rural need to be positive ones so we feel encouraged to go rural once we graduate. Well-supported rural experiences and placement opportunities are cherished.
Yet nursing and allied health students continue to miss out, and so by definition does rural Australia. It is inequitable that these students are more likely to have to personally organise their placements and receive less financial support for accommodation and travel. These kind of barriers can end up deterring people from going rural when they graduate.
This was a major topic of discussion when the leaders of our 28 university Rural Health Clubs met in Melbourne recently for the NRHSN’s annual council meeting.
There was also a strong focus at this meeting on Indigenous health, in the wake of the latest Closing the Gap report. We were pleased to hear from the Department of Health, which reported good progress on the national training curriculum for culturally safe health care for Aboriginal and Torres Strait Islander people.
The Department is working with Curtin University on the development of the curriculum framework and expects it to be ready soon for national rollout. This is good news for us as future health practitioners and leaders who are committed to closing the gap.
Not such good news is that while the 2.6% intake target for Aboriginal medical students appears to have been met, other health courses are nowhere near that figure.
It therefore remains one of the NRHSN’s core goals to attract more Indigenous students into health courses and to support them through to graduation. Increasing the Indigenous health workforce is a key element in achieving better health outcomes for Aboriginal and Torres Strait Islander people.
As a network, we take practical action to encourage Indigenous school students to consider health careers. Last year, 145 Rural Health Club members attended 15 Indigenous community events across Australia reaching out to primary and secondary school students through workshops and health-based activities. We intend to broaden that engagement in 2015.
Our parallel Rural High School Visits program saw 300 Rural Health Club members travel to 120 country high schools where they spoke about healthy living and health careers to more than 5,000 country students. We do this because the evidence shows university health students from the country are more likely to return to work in the country once they graduate.
In deciding our 2015 priorities, we also agreed to advocate for mental health training for university health students so they can care for themselves and others, particularly in rural areas where mental health is a major issue. Promotion and training in mental health must occur at university level as it is integral to the development of resilient, healthy and confident practitioners.
Greater confidence in handling mental health issues is especially significant for students who will later work in rural and remote Australia. They will be more likely to take roles as mental health champions and advocates in their communities.
• David Khoo is a qualified nurse and fourth year medical student at Deakin University, where he became interested in rural health through the NOMAD Rural Health Club. He is currently on placement at Ballarat Base Hospital.
• The National Rural Health Students’ Network represents 9,000 medical, nursing and allied health students who belong to 28 university Rural Health Clubs. It is funded by the Australian Government’s Department of Health and supported by Rural Health Workforce Australia, the peak body for the state and territory Rural Workforce Agencies. More at www.nrhsn.org.au.
The 2015 Executive Committee of the National Rural Health Students’ Network.
Front: Danielle Dries, Indigenous Health Officer (ANU); Rebecca Irwin, Vice-Chair (ANU); Natalie Kew, Secretary (University of Melbourne); David Khoo, Chair (Deakin University)
Back: Felix Ho, Community & Advocacy Officer (Flinders University); Ankur Verma, Allied Health Officer (James Cook University); Jessica Leon, Nursing & Midwifery Officer (University of Notre Dame); Joshua Mortimer, Medicine Officer (UNSW).
While rural residents generally experience barriers to access to primary health care and intervention services, these problems are further exacerbated for people with disabilities. The shortage of rural-based therapists’ means that a person with a disability in a rural area is significantly disadvantaged in accessing early therapy intervention compared with peers living in metropolitan areas (Doherty, 2007). Research by Keane, Smith, Lincoln, and Fisher (2011), Chisholm, Russell, and Humphreys (2011), and Denham and Shaddock (2004) indicated that there is a shortage of therapists living and working in rural and remote areas of Australia. Its very appalling, considering Australia has signed the Convention on the Rights of Persons with Disability. Many recent policy changes for people with disabilities in Australia have been framed in terms of universal human rights and, associated with this, redressing inequalities. For example: The Commonwealth Disability Services Act 1986, the CDSA and subsequent disability legislation around the country has enshrined specific principles regarding people with disabilities. They are clearly accepted by every Australian government as being equal citizens, who are accorded the same basic rights as other members of Australian society (Yeatman, 1996). However, this does not justify the substantial problems in accessing appropriate health care that have been documented.
It is clear that therapy services provided in rural and remote areas are dependent on the availability, location, and expertise of therapists. Winterton and Warburton (2011) also indicated that an individual’s access to available services will also be dependent on variables such as transport, cost, and child or respite care. The specific needs of people with a disability living in the communities are not well understood and may be hidden to mainstream services.
As discussed in the blog, for this issue to be improved, workforce side should be enhanced. It is evident that recruitment to non-metropolitan therapy positions is difficult, yet there are not enough professional or facility in rural areas. Research into the allied health workforce in Australia by Keane et al. (2011), Lyle et al. (2007), and Smith, Cooper, Brown, Hemmings, and Greaves (2008) has showed that therapists who were born, trained or had student placements, and/or had family living in rural areas were more likely to seek and remain in employment in rural or remote. Workforce and service access issues are therefore inter-related and point to the need for new service delivery models. New models may include employing, training and supporting a person in a local community as a therapy assistant who works under the direction of a therapist to deliver regular and timely intervention.
Reference
Chisholm, M., Russell, D., & Humphreys, J. (2011). Measuring rural allied health workforce turnover and retention: What are the patterns, determinants and costs? The Australian Journal of Rural Health , 19 , 81 – 88. doi:10.1111/j.14401584.2011.01188.x
Denham, L. A., & Shaddock, A. J. (2004). Recruitment and retention of rural allied health professionals in developmental disability services in New South Wales. Australian Journal of Rural Health, 12, 28 – 29. doi:10.1111/j.1440-1584.2004.00546.x
Doherty, S. R. (2007). Could we care for Amillia in rural Australia? Rural and Remote Health ,7 (4), 768 (online).
Keane, S., Smith, T., Lincoln, M., & Fisher, K. (2011). Survey of the rural allied health workforce in New South Wales to inform recruitment and retention. The Australian Journal of Rural Health, 19, 38 – 44. doi:10.1111/j.1440-1584.2010.01175.x
Lyle, D., Klineberg, I., Taylor, S., Jolly, N., Fuller, J., & Canalese, J. (2007). Harnessing a University to address rural health workforce shortages in Australia. Australian Journal of Rural Health, 15 , 227 – 233. doi:10.1111/j.1440-1584.2007.00895.x
Smith, T., Cooper, R., Brown, L., Hemmings, R., & Greaves, J. (2008). Profile of the rural allied health workforce in Northern New South Wales and comparison with previous studies. Australian Journal of Rural Health, 16, 156 – 163. doi:10.1111/j.14401584.2008.00966.x
Winterton, R., & Warburton, J. (2011). Models of care for socially isolated older rural carers: Barriers and implications. Rural and Remote Health, 11, 1678 (online).
Yeatman, A. (1996) Getting Real: the interim report of the review of the Commonwealth/State Disability Agreement (Canberra, Australian Government Publishing Service).