Healthy doctors practise better medicine: supporting the rural & remote health workforce now and into the future.

Mrs Inara Beecher1

1Country SA PHN, Nuriootpa, Australia


It is widely recognised that health professionals who are well balanced and healthy are able to provide higher quality patient care through enhanced empathy, and through being less likely to make mistakes due to stress and fatigue. Unfortunately, health professionals are often more diligent in caring for their patients than they are for themselves. In addition to optimising their health for personal wellbeing, health professionals also have a professional obligation to maintain their own health. Health professionals who are recognised to be particularly at risk of having difficulty accessing care are rural & remote GPs. It is vital for every GP to have their own GP, but can present issues when in a small and sometimes isolated community.

Doctors’ Health SA Ltd (DHSA) is a not-for-profit company established to improve the health of the medical profession for the good of the community. The Country SA PHN has supported the work of DHSA, through its Grant program, to connect and support general practitioners across rural & remote South Australia. DHSA is a comprehensive service that offers clinical services and education programs to support the medical profession across all stages of their careers. The end goal of DHSA activities is to make sure that doctors and students enjoy all of the benefits of on-going prevention, check-ups and GP care that includes providing access to the wider health system. The Country SA PHN Grant has created the opportunity for DHSA to pilot a telemedicine service for rural & remote doctors and medical students on rural & remote placement.

This paper will summarise the DHSA activities commissioned by Country SA PHN and the benefits provided to rural & remote GPs in SA. It will demonstrate how the service operates, the opportunities & challenges and discuss the pilot project utilising telemedicine for increasing service delivery.




With more than 20 years of health care experience, 16+ in Primary Health Care, including a large amount of time in rural SA settings and time spent working closely with Aboriginal communities.  Inara is a Registered Nurse with direct health care experience across primary and acute care.

Fellow of the Leaders Institute of SA, Governor’s Leadership Foundation (GLF) program 2011, Inara is also a Certified Health Informatician Australasia (CHIA), has been Heart Foundation Nurse Ambassador and previous mentor for the University of South Australia Immunisation course.  Inara is very passionate about achieving positive health outcomes for the people of SA.

Do regional universities produce rural dentists? A snapshot study examining dental graduates of 2015.

Ms Lisa Lim1, Mr Shaiel Parikh1, Ms Nadia See1, Mr Kaejenn Tchia1

1James Cook University, Smithfield, Australia


Rural and remote areas experience ongoing challenges with recruiting and retaining dentists, which results in workforce shortages where the need for oral health services is greatest.  The maldistribution of the dental workforce is evident nationwide, with metropolitan cities demonstrating a proportion of 56.2 dentists per 100 000 in metropolitan areas as compared to 22.9 dentists per 100 000 in remote/very remote areas.

Underlying this maldistribution of dental practitioners is the difficulty rural communities face in attracting and retaining dental graduates. The motivational factors that persuade and dissuade dentists from practising in rural and remote locations have been well identified in previous studies. However, literature that reports on whether or not the Australian university attended has an effect on practice location is scarce.

The aim of this study is to explore the intentions and destinations of dental graduates who completed their degrees in 2015, inclusive of all Australian universities that offer five year dental programs. This focus will enrich the understanding of dental graduate movements upon entry to the workforce. The findings will reveal whether there is a relationship between attendance at a metropolitan or regional university and the likelihood of graduates working in a rural or remote area.  These findings will inform discussion about the current trends of graduate movement and provide insights into whether exposure to rural curricula at university successfully increases rural motivation.  Modern technology will play a vital role in data collection particularly due to the younger demographic (anecdotally) of our target population; specifically, our reliance on social media avenues for the distribution of the online survey. The outcomes of this pilot study have the potential to be of interest and use in providing further insight into why dental graduates ‘go where they go’.




Mr. Kaejenn Tchia is a fourth year dentistry student from James Cook University. As part of his studies, Kaejenn has successfully completed units in health and health care in Australia, health professional research, health promotion, lifespan development, statistics, as well as rural and remote primary and public health care. Aside from his academic studies, Kaejenn is the current president of the James Cook University Dental Student Association Inc. and was also the Rural Officer in 2016 for the Australian Dental Student Association. Kaejenn has strong interests in rural health and hopes to work in a rural setting in the future.


Under-reporting of personal violent incidents by remote area nurses

A/Prof Sue Lenthall1, Ms. Heather Keighley2, Mr Rod Menere3, Ms Karen Collas1, Professor John Wakerman1

1Flinders NT, Flinders University, Katherine, Australia, 2Northern Territory Department of Health, Darwin, Australia, 3CRANAplus, Adelaide, Australia


Violence towards RANs has become a significant issue. We know from previous studies that levels of violence faced by RANs are high, however little has been known about the levels of reporting of violent incidences by RANs. A structured questionnaire distributed to nurses working in very remote regions across Australia in 2010, asked respondents how often they had reported incidents of personal violence in the preceding 12 months. Responses were categorised as never, 25% of the time, 50% of the time, 75% of the time or every time.  Only 21.3% of respondents reported incidences of violence every time, while 41.5% of respondents never reported violent incidences.  Anecdotally, reasons for underreporting include a mistrust of management, a belief that nothing will be done, or a view that it wasn’t really that bad. We need to know more about why these incidents aren’t reported and take action to address these underlying reasons.  We have developed a survey to examine why some RANs don’t report incidences of violence and we would like to invite conference participants to participate.  We’ll feedback the results of this survey in the CRANAplus magazine and at the next conference.




Associate Professor Sue Lenthall has worked extensively in remote communities in Queensland and central Australia as a remote area nurse before becoming involved in the education of health professionals including Indigenous Health Workers, nurses and medical practitioners. She has completed a teaching degree, a Master of public health and tropical medicine, and a PhD aimed at reducing occupational stress among remote area nurses in the Northern Territory. Sue was the foundation course coordinator of the remote health practice program and is currently the director of the Katherine campus, Flinders NT, Flinders University.

Barriers to timely discharge: An outer metropolitan General Surgical unit’s experience

Dr Domenic La Paglia1, A/Prof Shiran Wijeratne2

1Western Health, Melbourne, Australia, 2Werribee Mercy, Werribee, Australia



We have conducted a comprehensive audit of 125 surgical admissions over a 3-month period in an outer metropolitan hospital. Challenges faced by our health service include lack of access to critical care beds, lack of availability of specialised services and lack of an integrated digital medical record, which are factors faced by many rural health services. These factors have been shown to cause delays to patient care and have lengthened the average hospital stay, unnecessarily consuming taxpayer funds. This has highlighted several areas where technological advances and implementations could be utilised to streamline processes and reduce delays.

What is happening in your project/ health service/or what has been your experience:

Our health service lacks a critical care facility, meaning any high acuity patients must be transferred in order to receive appropriate care. We face ongoing challenges in securing beds for transfer and there are often lengthy delays as a result. In our audit three patients were shown to have delays to transfer of greater than 24 hours, compromising patient care. Nine patients experienced significant delays while awaiting theatre availability. Multiple patients required transfer for specialised procedures such as ERCP and experienced delays in the process. Many of these delays were a result of inefficient processes which exist to locate an appropriate transfer destination. Furthermore, the lack of any digital medical record to process patient information, discharge letters and summaries and scripts compounded these issues.


The implementation of readily available technology to streamline processes and improve data records would be cost effective and would improve service delivery at public health services in regional Australia.




Dr Domenic La Paglia MBBS DipAnat MPH MSc


Technology as an innovative way to meet the expressed needs of Aboriginal Australians and their families living with Machado Joseph Disease: an overview of MJD Foundation technology enabled communication and social and emotional wellbeing programs

Ms Desiree LaGrappe1, Ms Allison  Grootendorst1, Ms Libby Massey1, Ms Rebecca Amery2

1MJD Foundation, Alyangula, Australia, 2Charles Darwin University, Darwin, Australia


Machado Joseph Disease (MJD) is a devastating genetic neurodegenerative disorder experienced globally.  Initially causing impaired muscle coordination, MJD progresses to a total lack of voluntary muscle control and severe permanent physical disability.  MJD prevalence in the Northern Territory (NT) Aboriginal Australian population is thought to be the highest in the world and is certain to increase¹.  Due to the disproportionate numbers of Aboriginal Australians affected, their geographic dispersion, and scarce remote services, innovative, holistic ways to support and meet the complex needs of individuals and families is critical.

To this aim, the MJD Foundation (MJDF) seeks to provide a better quality of life for Aboriginal Australians and their families living with MJD.  The MJDF strives to reflect the expressed needs of people with MJD and their carers in its programs and research by maintaining close and functional relationships with clients.  As Aboriginal Australians are increasingly using technology in their everyday lives, the MJDF has been working with families to explore technology’s role in supporting the communication and social and emotional wellbeing effects of MJD.

This presentation will describe a fourfold interconnected program for people affected by MJD comprising a communication group, a private industry partnership to develop a new mobile app, technology enabled, practical social and emotional well-being strategies, and a qualitative research project.  Technology has potential as a culturally appropriate, responsive tool to grow the capacity of people living with MJD and their families to address barriers and facilitators to engagement and improve quality of life.

₁ Macmillan J. Machado Joseph Disease SCA3. [lecture notes on the Internet]. [Herston (AU)]: Genetic Health Queensland; 2011 [cited 2017 May 04]. Available from:




Desireé LaGrappe is nationally Registered Nurse who qualified in the USA. She migrated to Australia to pursue her passion in community and global health.  She also has a medical research background with a strong focus on women’s health and its intersection with social emotional wellbeing, including mental health. She joined the MJD Foundation in September 2014 and currently holds the position of Research Officer, supporting the MJD Foundation’s core activity of research under the direction of Director, Research & Education – Libby Massey

CATCHing the Hearts of country SA – The future of Cardiac Rehabilitation as applied through the Country Access to Cardiac Health (CATCH) program

Mrs Inara Beecher1

1Country SA PHN, Nuriootpa, Australia


The provision of cardiac health services in remote areas of Australia has many challenges. It is a matter of health equity that residents of remote communities have access to quality evidence based services as close as possible to where they live.

There is very strong research which demonstrates that if a patient accesses a cardiac rehabilitation health professional soon after experiencing a cardiac event, they have a much better chance of reducing their risk of having a further cardiac event or even dying. For many rural and remote people, access to health professionals can be a struggle for routine care; cardiac services are often more difficult again.  It is very important that rural people receive cardiac services where their family and supports are located and that services are also culturally safe/appropriate.

The CATCH (Country Access to Cardiac Health) program enables those living in country South Australia access the same level of follow up support after a cardiac event as in metropolitan areas.

Country SA PHN, which exists to bridge the gap of health equity in regional & remote South Australia, has funded the CATCH program as part of efforts to prevent subsequent cardiac events and to reduce the number of preventable hospitalisations. The CATCH program was rolled out state-wide in February 2016 and monitoring of the program is demonstrating improved patient outcomes.

The CATCH program enables patients to be actively involved in managing their ongoing heart health, which is leading to their improved health outcomes, and an overall reduction in hospital re-admissions.

Case study examples will summarise the CATCH program and the benefits it is providing to rural and remote cardiac patients in SA. It will demonstrate the opportunities, challenges and  highlight future plans to further utilise technology, such as video conferencing,  for service delivery.




With more than 20 years of health care experience, 16+ in Primary Health Care, including a large amount of time in rural SA settings and time spent working closely with Aboriginal communities.  Inara is a Registered Nurse with direct health care experience across primary and acute care.

Fellow of the Leaders Institute of SA, Governor’s Leadership Foundation (GLF) program 2011, Inara is also a Certified Health Informatician Australasia (CHIA), has been Heart Foundation Nurse Ambassador and previous mentor for the University of South Australia Immunisation course.  Inara is very passionate about achieving positive health outcomes for the people of SA.

Talking across borders: A national response to high rates of Sexually Transmitted Infections in remote Australia

Ms Jessica Thomas2, Ms Katy Crawford1

1Kimberley Aboriginal Medical Service, Broome, Australia, 2South Australia Health & Medical Research Insitute, Adelaide, Austraia


The South Australian Health and Medical Research Institute (SAHMRI) have been commissioned by the Commonwealth Department of Health to work in partnership with five Aboriginal and Torres Strait Islander health peak bodies across four states and territories and local Aboriginal Community Controlled Health Services to implement a health promotion and a primary care enhancement project to raise awareness of STIs and BBVs across remote communities in Australia.


SAHMRI is working in partnership with Aboriginal Health Council of South Australia (AHCSA), Aboriginal Health Council of Western Australia (AHCWA), Aboriginal Medical Services Alliance of Northern Territory (AMSANT), Queensland Aboriginal & Islander Health Council (QAIHC) and the Kimberly Aboriginal Medical Service (KAMS). Regional STI Coordinators are funded by the project and based within the peak health bodies in each jurisdiction.


Effective communication between project staff has been integral in the planning stage of this project. Technologies such as SharePoint and Skype have been used to closely collaborate despite immense geographical distance between positions. This has reduced the need for face to face meetings and therefore minimised travel expenditure.

The diversity in terms of remote communities across Australia in social, cultural and geographical aspects is vast. To embrace this diversity and support a community driven approach technologies have helped the team to communicate and collaborate. The team can be anywhere with mobile phone coverage and can access all project materials on any device without trawling emails looking for the most current version of a document.


Moving forward the Remote STI project will explore further technology to continue this cross border communication. Despite the availability of technology, there are still challenges in accessing this due to remote setting coverage limitations




Jessica Thomas is the National Coordinator for the Remote STI project based at SAMHRI in Adelaide. She his public health professional with experience in the implementation and evaluation of health promotion programs in rural and remote settings.

Katy Crawford is the Kimberley Coordinator for the Remote STI project based at Kimberley Aboriginal Medical Service. She is a registered nurse with previous experience in public health, specialising in STI control.


Kalumburu Strong Girls and the future

Ms Sherrie Vickery1

1KPHU, Kalumburu, Australia


Kalumburu is a remote indigenous community 596 km NW of Kununurra, and it is the most remote community of the East Kimberley region. In Kalumburu, there has been a significant history of sexual abuse and other trauma, in recent years.

Kalumburu Strong Girls was a health promotion program set up for young women in the Kalumburu community. This abstract hypothesises that these girl’s will be at a reduced risk of family and domestic violence due to their improved self- esteem , support from  peers and professionals  within the group and the knowledge of safe behaviours  and social capital. The target group was aimed at girls aged from 12 to 16 years old. The program was a locally designed program for young women, especially those who are experiencing issues including:

  • Low Self Esteem/Self Worth
  • Health issues such as sexual health, diabetes, APSGN and hygiene.
  • Trauma experienced with family and domestic violence.
  • Suicidal ideation and self-harm.
  • Substance abuse.
  • Boredom


The Kalumburu Strong Girl’s commenced in May 2016, when RAN’s at Kalumburu Clinic could see the need for intervention. There was a gap evident to clinic staff that young females had no resources available to them other than school and the clinic: it was increasingly evident that there was increased clinic presentations and crime rate of young females in Kalumburu.

The topics addressed included healthy lifestyles, personal- hygiene, nutrition, sexual health, mental health and chronic disease prevention. Increasing access to information technology is major aim of the group for this year with the development of a Facebook page and YouTube clip.

Preliminary findings from group evaluation, have shown that  by participating in the group the girl’s feel empowered by knowledge and have increase self-control  and motivation for greater decision making capacity and  developmental opportunities.




My name is Sherrie Vickery and I work as a Remote Area Nurse Specialist for Kimberley Population Health Unit, at Kalumburu Clinic. I have worked at Kalumburu Clinic since March 2016.

I have been working in nursing since 1985. I have worked in many varied settings from NT to QLD, in remote health over the years.

My qualifications include Mental Health nursing, Bachelor of Nursing and Post Graduate Certificate in Remote Rural Emergency Nursing.

Blasting into the future – at a snail’s pace: The Bedourie Primary Health Clinic Telehealth Story

Mrs Danielle Causer1, Mrs Louise  Poole, Ms Kylie Osborn

1Central West Hospital And Health Service, Longreach, Australia

Communications is vital particularly in remote areas. The Central West HHS has a total area of almost 400,000Km2 or 22% of the states land mass. In addition to this, the Australian Bureau of Statistics (2001) Australian Standard Geographical Classification Remoteness Area identifies the Central West as one of the most remote areas of Australia.

In 2014, Central West HHS took over the management of Bedourie Clinic. Bedourie is a small town located on land traditionally owned by the Wangkanguru People, in the Channel Country of Central West Queensland. Bedourie is approximately 2000 kilometres west of Brisbane, and 500 kilometres south of Mount Isa with a population of 283 at the 2011 census. Bedourie’s remote Primary Health Clinic (PHC) is challenged by geographical distances, isolation and extreme weather variances. This 1 remote area nurse on staff responds to and provides emergency care and outpatient clinic activity. Any presentation requiring admission or treatment outside of the scope of a PHC is transferred to Mt Isa Hospital by air. Bedourie PHC welcomes many visiting specialist in conjunction with our fortnightly RFDS clinics and now have access to telehealth video conferencing.

This presentation takes you through the challenges faced and successes achieved over the past 3 years. From slow connection residential grade satellite to NBN Sky Muster satellite that enables live videoconferencing. It was a very exciting development, not only for patient consultation, but for emergency presentations and clinical support. There are exponential opportunities for both patient and staff education and continuing professional development. We are hopeful that by late 2017, fibre networks will be deployed to the town enabling high speed Internet and live videoconference calls.

Whilst “at a snails pace”, there are many lessons learned surrounding community engagement, empowering staff, overcoming remoteness and isolation, managing from a distance and stakeholder engagement.




Danielle Causer – a Registered Nurse who has worked in various roles across Qld and NSW and  China. She is currently the Nurse Educator for the Central West HHS.

Louise Poole – a Registered Nurse working in the public sector predominantly in Regional & Remote areas of Qld, NSW & WA. For the past 4 years Louise has worked as the CNC Telehealth for the Central West HHS.

Kylie Osborn – currently the Acting Telehealth CNC for Central West HHS.  Prior to this she was the Emergency CN and various Nurse Manager position at Widebay HHS.


Retention of all staff in Remote Setting – Kutjunka a case study

Ms Julia Mcintyre1

1Kimberley Aboriginal Medical Services Limited , Broome, Australia


The provision of primary health care in an aboriginal medical service in remote communities of Australia has many challenges. Attraction and retention of suitably qualified staff raises challenges

What is happening in your project/ health service/or what has been your experience:

A brief description, purpose/objective of what it is, your key findings & implications as part of your discussion

for example:

As a major Primary Health Care Provide KAMS consistently strives to attract and retain skilled staff in the region. In 2010 KAMS was running at an attrition rate of over 200% for Remote Area Nurses in the Kimberley. This type of turnover has an enormous impact on our capacity to deliver a service as well as a financial burden of agency staff and continuity of care.

In 2013 we embarked on a journey to challenge this turnover and look at ways we could keep staff.

We asked questions like why are you leaving?  As well as looking at what other providers were offering.

Remuneration, staff housing, communication, leave entitlements were all reviewed.



These changes have seen a decrease in attrition to 39% in 2016. A very low utilisation of agency staff and a more stable workforce for community.




Julia McIntyre is the Executive Manager Work Force for the Kimberley Aboriginal Medical Services  located in Broome WA.  This portfolio is inclusive of Human Resources, RTO, and Workplace health and safety.

She has Masters in Human Resources and a Bachelor of Arts.

Prior to KAMS, Julia held a variety of senior executive roles in government in Victoria as well as working in the corporate sector across multiple verticals for over twelve years.  Julia began her career as a student nurse at St Vincent’s Public Hospital in Melbourne.

She is a Board Member of the Broome Youth Family Support Hub .