Lived experiences of women with primary infertility in rural Limpopo Province, South Africa

Dr. Ramakuela NJ1
1Department of Advanced Nursing, University of Venda, Thohoyandou, South Africa

Women who had never achieved pregnancy after adequate exposure to unprotected sex without using contraceptives tend to suffer primary infertility. It is a global reproductive health issue that affects individuals and couples. Among other factors contributing to primary infertility is sexually transmitted infections. The nature of research was alarmed with the experiences of women with primary infertility with a purpose of describing and exploring lived experiences of women with primary infertility. The study adopted a qualitative, and phenomenological approach using explorative design. The population was all women with primary infertility. Non-probability purposive convenient sampling was employed to select the participants aged 25 – 45 years attending infertility clinic based on the personal judgment of the researchers. Data was collected through in-depth one to one interview and guided by one central question was aked. Field notes were taken as the researcher met face to face with participants. Data was analyzed using Tesch eight steps of data analysis. Measures of trustworthiness were adhered to and ethical principle considered. Two main themes emerged: Spouses/ husbands not ready to test for infertility and lack of consistent consultations at fertility clinics. Conclusion and recommendations Government and policy makers to train more health professionals specializing in fertility to enhance quality care and provide human and material resources in all public health facilities providing fertility services. Participants to seek medical intervention immediately after 12 months of unsuccessful pregnancy and disclose their infertility status to lessen self-discrimination.


Dr. Ramakuela NJ is currently working as Senior Lecturer at the University of Venda. Dr Ramakuela received his Doctoral degree or PhD on 2012 from the University of Venda. Dr Ramakuela completed his Masters in Nursing from the University of Venda. She then worked at the University of Venda, served as Senior Lecturer. Dr. Ramakuela has authored several publications in various journals and books. Her publications reflect her research interests in Reproductive and Women’s Health. Dr. Ramakuela is also an Associate Editor of the African Journal for Physical, Health Education, Recreation and Dance. Dr. Scientist is serving as a member or fellow in Association of Women Empowerment in Vhembe District. She is currently in charge of ongoing scholarly project Palliative Care for Dignified Dying survey, Knowledge of water, health and Sanitation. Dr. Scientist is awarded or honored by The University of Venda Research and Innovation Excellence Awards.

Research Interest: Dr Ramakuela is a healthcare Professional who specialized in reproductive and women’s’ health. Her PhD Model is entitled “A MODEL TO FACILITATE WOMEN’S COPING WITH MENOPAUSE”. Her model is being utilised by rural community based women to help cope with menopausal challenges they encounter.

Halls creek children and their future

Ms Ellen Williamson1

1KPHU, Halls Creek , Australia


Technology is important in maintaining the future health of babies and children and families. We have a very mobile population in the Kimberley and we need good information systems ( i.e Communicare) to monitor families throughout the area.  We also need to make use of the important data collected on children through the AEDC census.

This presentation ( video) will focus on providing the audience with a view of the early childhood services in Halls Creek, its remote location, and the importance of the organisations working together to maintain healthy families and children.

Following the video I will present a short presentation on the relevant statistics from the AEDC.  This will outline the child developmental areas in AEDC which shows that Halls Creek is one of the most disadvantaged communities in Australia with the number of children developmentally vulnerable ( approximately 45%) on one or more domains ( language and cognitive skills, communication, emotional maturity, and physical health and wellbeing). These AEDC results will indicate the need for more early childhood intervention services for this area and I will outline what services and technology innovations are required for the future health and wellbeing of Halls creek families.




Ellen is the current Chid health Nurse in Halls creek and works for WACHS. She has been in this role for the past 9 years. She is a qualified Child health Nurse and Midwife and is passionate about the health of the young babies and children in Halls Creek. She would like to see the community healthy and strong in the future and children learning and developing in a way that they can contribute positively to Halls creek community and Australia wide.

The role of organisational culture and systems on health professional’s feelings of safety in the remote health setting

Miss Jennifer Wressell1,2, Ms Bodil Rasmussen2, Ms Andrea Driscoll2

1mia online, East Geelong, Australia, 2Deakin University, Burwood, Australia


Workplace violence is a significant issue on the health industry with upto 80% of nurses experiencing verbal or physical assaults in the workplace.  Workplace violence has a flow on effect across an organisation resulting in high levels of professional burnout, difficulty with recruitment and retention and decreased quality of care.  At an individual level long term effects such as increased levels of anxiety, depression and post-traumatic stress have been identified as common amongst health professionals.

We wanted to explore two primary areas; firstly how remote area nurses felt in the workplace and their level of exposure to risk factors across environmental, client and occupational workplace characteristics.  Secondarily how organisational culture and risk management structure influenced response to workplace violence.  A theoretical proposition of our study was that workplace violence is such a common occurrence in the health workspace that health professionals have become desensitised to both assessing risks and the effects of violence on self.

In August, 2016 we collected data using a quantitative explorative descriptive design approved by Deakin University Human Ethics Committee.  Our study explored the experiences of 99 remote area nurses and health service managers working in remote health clinics across Australia.  Looking at how safe nurses felt within the remote health setting in conjunction with the organisational factors that influence feelings of safety.  This approach allowed us to identify some key occupational and organisational traits that could be developed as mitigating factors to minimise the effect of workplace violence on health professionals.




Jen is a Registered Nurse, Health Service Manager and Researcher who has worked in a variety of settings including remote Indigenous communities across Australia, Antarctica and Saudi Arabia.  Over the last 10 years Jen has become increasingly interested in the relationship between organisational culture, professional leadership, team development and nurses’ professional satisfaction levels and personal health.  As co-Director of ‘mia; mindful, innovative action’ she advocates for the implementation of risk mitigation strategies to reduce the long term effect of workplace violence.

Perspectives of Rural and Remote Health and Human Service Practitioners Following a Suicide Prevention Training Program: A Thematic Analysis

Ms Sandra Walsh1, Assoc Prof  Martin Jones1, Ms Lee Martinez1

1Department Of Rural Health, University Of South Australia, Whyalla Norrie, Australia


There are well established training programs available to support health and human services professionals working with people vulnerable to suicide. However, little is known about involving people with lived experience in the delivery of suicide prevention training with in regional and remote communities. In 2015, eight suicide prevention training workshops were conducted with health and human services workers. All 248 participants lived and worked in South Australian regional and remote communities. A purposive sub-sample of 24 participants across all eight sites were interviewed after the training.  The aim of these interviews was to explore the experiences of health and human services workers of a suicide prevention training program in regional and remote South Australia which included meaningful consumer involvement in the delivery of the training. A thematic analysis of the interviews identified five themes: Consumer is key, It is okay to ask the question, Caring for my community, I can make a difference, and Moving forward. The overall meta-theme was “Consumer involvement in suicide prevention training supports regional communities to look out for people at risk of suicide”. A number of elements have been highlighted to the research team such as the importance of engaging with community to understand their particular needs.  The value of providing multi-disciplinary training to multidisciplinary workers in regional and remote communities affords participants the opportunity to come together and discuss community approaches to crucial and delicate topics such as suicide prevention.  Online learning and training ‘away from base’ can provide participants with a meaningful educational experience, however training provided in the community offers participants something unique.  The authors contend that this kind of training delivery is key to a number of topics that benefit from a whole of community approach.




AssocProf Martin Jones is Project Director: Department of Rural Health. He has worked for over 20 years as a mental health nurse and has conducted research into the physical health of people living with a serious mental illness for several years. Martin is an experienced researcher investigating workforce development, service reform, and widening user access to evidence based treatment and care interventions. Martin has led academic teams internationally in the delivery of educational programs in mental health dimension of physical health problems, extending service user choice, and treatment of disorders. He has advised WHO projects in Russia, Iraq and Serbia.


Submission to perform a fun ‘skit’ at the CRANAplus conference 2017.

Miss Vanessa Page1

Derby Hospital1


We will have a pregnant woman labouring in Fitzroy Crossing (260km away from Derby) and calling for the Midwife.

Two Derby Midwives will ride their bikes into the venue to the sound track of Call the Midwife. We have fabulous costumes to wear – very similar to those worn by the Midwives on the ABC series.

Along the way to Fitzroy Crossing the 2 Midwives will encounter a number of obstacles…

1. Our first stop for morning tea will be at Windjana Gorge where we will pull out our mobile phones and take some ‘selfies’ with the ‘freshies’ (crocodiles).

2. We will encounter being charged by a scrub bull.

3. We will get a flat tyre.

4. We will encounter the ghost of Jandmarra near Tunnel Creek.

5. We will dodge some road kill.

6. We will have to put our gum boots on and wade through the flood waters of Plum Plains (just near FX).

In between each ‘obstacle’ the labouring woman will cry out and call for the Midwife again.

When we finally arrive in FX our labouring woman will have already given birth! So we then have to turn around and ride all the way back to Derby again!

The above obstacles may change a little, but it gives you the idea.

We will require microphones, the ability to play the ‘Call the Midwife’ theme song throughout the skit, and also display a slid show of West Kimberley photographs as we ride all the way to FX.

The skit will go for about 10min max. If you think this would be suitable I would prefer that we perform this early in the conference schedule as I may only be available early on due to having facilitated a course just prior (I will be needing to get back to work).



To come.

Expanding horizons: Using virtual orientation tours to promote rural, remote and Aboriginal health

Dr Merylin Cross1, Associate Professor Tony Barnett1, Ms Sharon Dennis1

1University Of Tasmania, Newnham, Australia

Projected workforce shortages and health disparities in rural, remote and Aboriginal health are driving the political push to double the number of health science students that do rural and remote placements. However, small health services have limited capacity to field inquiries or repeatedly orientate and supervise students throughout the year, academics are often unfamiliar with particular health services and students often have misconceptions and fear the unknown.

Working in partnership with twenty rural, remote and Aboriginal health services, our team has developed a technology-mediated solution that meets the needs of all stakeholders. Our aim was to co-construct a virtual web-based orientation platform to showcase participating health services.

This paper reports the utility of virtual orientation tours from the perspectives of service providers, faculty and students. Partners and faculty that manage student placements value their consistency and flexibility. Students from any discipline or education provider can access the tours whenever convenient. Health service staff report the tours help to orientate new staff and provide a useful mechanism to field inquiries by prospective employees.

Virtual tours of health services can bridge the tyrannies of distance and bring practice settings to life. They demystify unfamiliar services, attract interest in-context, allay anticipatory anxiety and begin orientation before arrival. These tours demonstrate that technology can provide an effective way for placement and education providers to expand viewers’ horizons about rural, remote and Aboriginal health, and in the process, create possibilities to recruit new staff and tell community members about the health services available.


Dr Cross has a background in nursing, nursing education, quality management and sociology. Nursing in a small rural hospital in Queensland was the catalyst for a career in rural nursing involving everything from clinician to Deputy Director of Nursing/Director of Nursing (Education). Merylin is a senior lecturer in the Centre for Rural Health at the University of Tasmania. Before that she was at Monash University during which she coordinated a four year Bachelor of Nursing and Rural Health Practice and taught face to face and by distance education in Australia and in Papua New Guinea, Malaysia, Singapore and Hong Kong.

Telecommunications, critical infrastructure for increasing patient, family and community interactions with and between health providers especially in Remote Australia.

Dr Robert Starling1

1 GeoScience Computer Service, Greenwich, NSW, Australia 



Reliable connectivity to the internet provides options for improving access to health care and reducing costs of delivery especially in remote and very remote Australia (80% of the country – CRANA country).  Identification and use of appropriate technology involves change. The workforce must be empowered to contribute to change.  Adaptability, confidence and imagination make an enjoyable workplace.

What is happening:

The Remote health workforce continues to change.  Long term staff are fewer, staff turnover is higher. Deep knowledge of what works within your communities resides mainly with the nurses, health workers and Aboriginal health workers.

Continuity of care and clinical risk reduction are underpinned by continuity of timely, accurate and complete data patient data.  Integrated single records for clinical, allied and mental health accessible over the internet allow knowledge of a patient to be transferred between providers. Risks, mitigations and preventative steps may be shared with families and groups of influence/association (clusters).

Policy and funding for remote Australia primary and population health has never been less responsive, more confused or the imperative for health services to be successful businesses more critical.  Businesses thrive on certainty, a vane hope in these tumultuous times.

More change is coming, reliable local wireless telephony and data allow remote monitoring of patients and environmental conditions.   A technology-empowered workforce will reduce isolation, costs and risk through enabling pro-active interventions – who will drive this change? What do social media tell us about the state of the health our community?


Do you see mobile voice and data enabled technologies in remote health as an opportunity, a threat or someone else’s problem?




Adviser to Member Services in Information management to support continuity of well-being and care plans (clinical, allied health, health promotion), understanding population health and business modelling and planning, Continuous Quality Improvement.  Also contribute to national inquiries, policy reviews and national primary health strategies for Aboriginal and Torres Strait Islander peoples along with telecommunications for health and community capacity building.

A little Hocus PoCUS – applications of point of care ultrasound in a remote setting

Ms Alanna Watson1

1IOTHS – CKI, Cocos (keeling) Islands, Australia


PoCUS (point of care ultrasound) is a quick bedside tool which can be used as an adjunct to the physical exam or provide guidance for procedures.  Applications for PoCUS have made their way into most areas of clinical practice and are utilized in the US, UK, and Canada. (Canadian Association of Radiologists 2013)

Cocos (keeling) Islands is one of the most remote health centres in Australia.  A small chain of islands in the middle of the Indian Ocean 3000km from the mainland.  We have a full suite of POC equipment, including 2 ultrasound machines.

Utilizing the ultrasound machines as part of the POC diagnostic suite, we have been able to answer questions in the clinical exam which have improved our treatment decisions and patient safety.  It has proved invaluable with acutely unwell patients, answering time critical questions.  It has been most valuable in the day to day operations.  Adding an extra piece of evidence to make evacuation decisions, or guiding invasive procedures.

In my presentation I hope to inspire other RANs to explore the applications of PoCUS in their clinical setting.  I will talk briefly about how U/S works and safety considerations.  Discuss the numerous applications in the remote setting and some that I have found particularly useful.  In conclusion, I will talk about how to get started, offer a suite of interesting links, and training options.




Clinical Nurse Manager – Cocos (keeling) Islands, Indian Ocean Territories Health Service

(How) Can technology support Remote Area Nurses in Quality Use of Medicines?

Mr Tobias Speare1

1Centre For Remote Health, Alice Springs, Australia


The presentation will discuss the use of online education and technology in reducing access barriers to professional development and resources for the remote health workforce, in particular the experience of developing and conducting an online pharmacotherapeutics course.

Nurses form the backbone of primary care in remote Australia and provide vital services, especially in relation to chronic disease management. Remote Area Nurses practise at an advanced level often with limited or distant medical support.  This highlights the need for advanced knowledge and skills management.

Geographic isolation, poor access to technological infrastructure and financial factors, such as funding to support travel or cost of attendance, have been identified as the major barriers to remote health workforce undertaking professional development. The Australian Primary Health Care Research Institute found that effective orientation and continuing professional development is vital for ensuring an adequately skilled and professionally satisfied workforce, and that continuing professional development is an important factor in workforce retention. In 2003 the Centre for Remote Health developed a course in medicines use in disease management. Consultation with stakeholders identified that access and geographic isolation, to the face-to-face course, was a significant and costly barrier. However, in situations where internet access is unreliable, how else can nurses be assisted to achieve the desired learning outcome of critical reasoning to ensure safe and effective use of medicines, and be provided in an engaging way?

The resultant self-paced online course based on adult learning principles encourages clinical reasoning, knowledge development and use of recommended evidence based information sources while remaining in the communities where they are providing care. Pharmacotherapeutics for Remote Area Nurses has been well received by nurses and health service providers, and is being used as an introduction for many nurses new to the remote context.




Tobias Speare is the pharmacy academic at the Centre for Remote Health, a joint University Department of Rural Health of Flinders University and Charles Darwin University. Toby possesses a keen interest in improving health care in a holistic fashion. In particular improving the Quality Use of Medicines through education and research.

Balancing technology with human relationships in the remote health setting.

Ms Deborah O’Neill1

1Rural Lap, Coffs Harbour, Australia


Technology provides unparalleled support to clinicians practicing in some of the most isolated areas of Australia. Often without the support of a doctor, remote practitioners are equipped to provide life-saving treatment by virtue of technological advances.

However, the unique nature of healthcare in the remote health setting brings with it a second consideration that is tantamount to the effective use of technology. The awareness and practice of culturally safe behaviours and attitudes can enhance the outcomes of care provided. They facilitate and underpin the essential inter-personal relationships necessary to maintain culturally safe outcomes with remote community members.

To practice successfully, healthcare providers in remote communities must be equipped with strong inter-personal skills, but most importantly, culturally sensitive and appropriate skills, the absence of which, will diminish the scope for the use of any advanced clinical skills or technology.

Optimum health outcomes in remote often rely on the connection the community senses between itself, the clinic, and the ownership that community attaches to the clinical and interpersonal space.

Community consultation enables community members to govern and develop ownership of their health service delivery, drawing direct links with the Alma Ata declaration of “health for the people, by the people”. Consultation should be entered into when introducing technological or systematic changes, or indeed, broader program changes such as the introduction of new health initiatives, the successful implementation of which can be directly attributed to inclusive community involvement from the initial development phase.

Through scholarly research and first-hand remote health practice experience (including highly successful health program implementation), this presentation will explore the positive and negative impacts of technology in a remote health setting. It will examine the all-important balance between technology and the patient/client-clinician relationships. Also discussed will be the imperative nature of community ownership and its impact on optimum healthcare delivery.




I commenced my career in remote nursing in 2010,  as an N3 in Yuendumu.   I progressed to an N4 and N5 clinic manager, living there for 2 years.  The following 3 years as clinic manager at Utj, during this time I attained 3 years clinic accreditation and the clinic was reviewed by Flinders University for the provision of outstanding primary health care.

I have been fortunate to work for NAHRLS now Rural LAP which has taken me to some of Australia’s most remote communities such as Kiwirrkurra and Oak Valley.  I have worked in over 25 remote clinics in NT, WA, SA and the Torres Strait. I am also a Remote Educator with Aspen for RAHC.

I completed the Graduate Certificate in Remote Health Practice and Graduate Certificate in Remote Health Management with Flinders University which has provided me with invaluable training for remote practice.