Eliminating Crusted Scabies: The One Disease Experience in Remote NT Communities

Ms Michelle Dowden1, Ms Meg Scolyer1, Ms Irene OMeara1, Ms Hannah Woerle1

1One Disease, Darwin, NT, Australia


Aboriginal communities in the Northern Territory, Australia, have some of the highest reported rates of scabies in the world. Secondary skin infections associated with scabies can lead to ongoing heart and kidney complications.
In 2014, scabies was added to the World Health Organisation’s list of Neglected Tropical Diseases (NTDs); and in 2017, the scabies classification was elevated from Category B to Category A in the NTD profile. Scabies is the only WHO Category A NTD that does not yet have a roadmap for Elimination.

What is happening:
To date, the not-for-profit One Disease is the only organisation with an informed, planned approach for addressing Crusted Scabies in the Northern Territory; and is leading the way in developing a framework for Elimination. One Disease aims to Eliminate Crusted Scabies from the NT by 2019, and across Australia by 2022.
Preliminary work in readiness for Elimination of Crusted Scabies has seen One Disease focus on two key aims: Improve detection and diagnosis of Crusted Scabies; and prevent recurrence of Crusted Scabies episodes requiring hospital.
Utilising a quality improvement framework, One Disease alongside local health services, is reshaping health systems, to better facilitate coordinated care for people with Crusted Scabies. One Disease are enabling systems change at multiple levels – family, community health centre, and hospital.

Providing leadership for improvements in detection, diagnosis, treatment, and management of Crusted Scabies, has seen a more coordinated approach for controlling Crusted Scabies – the first step in Elimination of this debilitating, yet entirely preventable disease.


Meg is an RN, with post grad experience and qualifications in community development and health promotion. Meg’s role at One Disease involves working in partnership with local communities in West Arnhem Land, to develop locally owned strategies for improving management of Crusted Scabies. A core element of this work is providing support and education to individuals, families, remote clinicians, and hospital staff; but also includes advocacy; care coordination; screening and active case finding; building the capacity of local people to manage scabies; development of care management plans for clinical information systems; updating clinical guidelines; and practice based research.


Where are the nurses who will look after rural and remote when we are all gone?

Greta Webb1, David Schultz2,3

1Aspen Medical

2Rural LAP

3Healthcare Australia


• There is a significant worldwide challenge in recruiting and retaining skilled nurses. This is especially true for rural and remote health services, which continue to experience significant, ongoing nursing shortages.

What is happening?
• The current workforce is aging with nearly one third due to retire in the next ten years
• One third of all nurses who graduate leave the profession within 5 years
• Nurses working in rural and remote settings need higher levels of knowledge and skills to provide first line primary and emergency health care due to the scarcity of doctors in these settings. The knowledge and skills, and ability to use them under pressure takes significant time to develop.
• A move to part time work by many experienced nurses further exacerbates the shortage and ability to transfer skills
• Critical shortages of nurses leads to those in the workforce working extra hours/on call increasing their fatigue and thoughts of retirement (and increasing risks of serious errors)

It’s a scary feeling being the person who responds to an emergency when there is no MET team to call. All the hero nonsense goes out the window as you put your knowledge, skills and experience on the line. We need to be developing a workforce ready for the challenge.

• Some good things are happening to address this issue, e.g. students undertaking placements in rural and remote, courses specifically designed to teach the knowledge and skills needed.
• Governments need to research appropriate incentives to attract and retain rural and remote nurses, such as the Rural LAP scheme.
• Employers need to ensure they have systems in place to address the needs of staff e.g. workforce development plans and support to study
• We as individuals must be supportive of new employees (and relievers) so that they will want to stay and develop into our future workforce.


Greta Webb is a Registered Nurse proudly working for Aspen Medical as a member of their Rural Locum Assistance Program (Rural LAP), in rural hospitals and remote clinics.

Rural LAP is a part of the Australian Government-funded service that focuses on supporting health professionals, nursing and allied health, working in rural and remote settings. The Rural LAP team recruits highly skilled and experienced locums to enable those health professionals to attend educational requirements to maintain registration and update their skills, and to be able to obtain their hard earned leave.

Student Exposure to Rural Communities

Carolyn Reimann1, Miss Ashley Brown1

1National Rural Health Student Network


The NRHSN recognises the importance of well-supported and positive rural placement experiences to attracting and supporting a future rural and remote health workforce. Rural and remote placements offer the opportunity for medical, nursing, midwifery, allied health, pharmacy and dentistry students to further their professional development in an environment that offers many new experiences. For an individual student a positive rural placement can stimulate an interest in rural and remote Australia as a place to practice their profession. Alternatively – a poorly supported placement can turn people away from that. So, good placements matter.

Students who have had placements in rural communities will comment on the importance and impact that these placements have made for them. How it has shaped their career goals, and how educators could improve placements. They will touch base on both university placements and placements such as the John Flynn Placement Program.

It is not only placements where students have the opportunity to be exposed to rural communities. Individuals from our Queensland Rural Health Clubs, specifically Club RHINO for this presentation, have an added bonus of having Health Workforce Queensland support other opportunities for exposure. A Joint Rural Health Club Weekend and a Grow Rural Program are two examples of how Queensland health students of all disciplines are gaining exposure to our rural communities. A student who has attended a Joint Rural Health Club Weekend and is on the Grow Rural Program will discuss the importance of multidisciplinary exposure in rural communities throughout their degree.


Ashley Brown, 4th year Medical Student University of Tasmania, Community & Advocacy Officer of the NRHSN

Rural High School Visits

Carolyn Reimann1, Miss Ashley Brown1

1National Rural Health Student Network


The NRHSN’s Rural High School Visit (RHSV) program has been developed to encourage students in rural areas to study a health discipline at a tertiary level. Research has shown students with a rural background are more likely to go rural when they are qualified. Each Rural Health Club (RHC) must organise and participate in at least two RHSVs each year. Participation can be as an individual RHC or jointly with others.


The RHSV program is designed to:

• Inspire rural students to pursue health careers.
• Increase your knowledge of rural community health.
• Gain skills in working in a rural community.
• Gain further connections with rural health workers and communities.
• Gain positive rural experiences.

The RHSV program can be delivered to all year levels of school students but should be targeted depending on the year. Years 8, 9 and 10 are a good year level to promote health careers and education to. Be mindful Year 11 and 12 students may not be studying the required subjects for health courses. It is also encouraged for RHCs to visit primary schools to help plant the ‘seed of inspiration’ early on.

Revisiting some of the same communities and schools from year to year helps to build ongoing relationships. It also assists continuity of messaging and gives role models for students to look up to and feel connected to.

This presentation would go over how RHSV’s are delivered, examples of some experiences from these RHSV’s and students perspectives of the impact they create.


Ashley Brown, 4th year Medical Student University of Tasmania, Community & Advocacy Officer of the NRHSN

A young nurses journey to rural communities

Jessie Stone1, Miss Amy Wenham1

National Rural Health Student Network


What are some of the barriers faced during nursing school?

As a junior nurse what are some of the questions you are finding yourself asking?

Where do you go from here?

How do you become a rural nurse?

These are just a few of the questions that will be touched on by the perspective of a young nurse. With the ambition of working rural, she has made an extra effort to navigate different paths throughout her nursing degree to ensure that she had adequate rural exposure. Jessie is now in her first year of nursing in Rockhampton and faces the questions of where to from here? She will share her story to nursing students, advice on how to get involved during school. Different clubs and opportunities that students should take advantage of. Then she will present from her perspective what some of her barriers were during school, and some of the challenges she faces now that she is making her way to becoming a rural nurse.


Amy Wenham is a final year Bachelor of Nursing (Advanced Studies) student at the University of Sydney. Currently serving as the National Rural Health Student Network Secretary and MIRAGE Rural Health Club President, Amy has a strong passion for rural and remote health. Having grown up in rural areas across the globe, this passion is something that she strives to employ with her nursing degree in the future.