Outreach Impact 1

OUTREACH IMPACT Issue 2, May 2016

health care where it’s needed most

The Outreach programs are made possible through funding from the Australian Department of Health. 2 Outreach Impact

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27 Front cover photo supplied by Martin Canning: www.martincanning.com28 Outreach Impact 3 Outreach Contents Impact FOREWORD CENTRAL Issue 2 | May 2016

Page 4 Page 16 Outreach Services Reducing wait lists in Blackwater Page 17 Page 5 Signature Story: ENT Surgery at Noosa Hospital Ann Maree Liddy Page 18 CEO, CheckUP Team approach making a difference in Gladstone A message from a patient Matthew Cooke Page 19 CEO, Aboriginal and Islander Health Provider Profile: Michael Young Council (QAIHC) Page 20 Improving health and well-being in Woorabinda Page 21 Working together in Woorabinda to make a difference OUTREACH SERVICES NORTH-WEST REGION

Page 6 Page 22 Outreach Regional Structure Provider Profile: Dr Claire Barrett Page 7 Page 23 Outreach by the numbers Pain Management in Deadly Ears on Mornington Island Page 24 Signature Story: Doris turns her life around Cooking up a storm in Boulia Page 25 Innovation Eye Health Team in Central West Queensland

SOUTH-EAST REGION NORTH REGION

Page 26 Page 8 Signature Story: Lifestyle change leads to Provider Profile: IUIH Audiology Team: Every wellness and weight loss child, every year Page 27 Page 9 Provider Profile: Dr Bill Boyd - Queensland doctor Signature Story: Brighter futures at the Murri hits the road to tackle obesity epidemic School Page 28 Page 10 Better Beginnings on Palm Island Signature Story: Meet Leslie Beckett, a Murriwarri Page 29 man Tackling diabetes together in Page 11 Partnership Providing Clear Sight for Queenslanders

We respectfully SOUTH-WEST REGION FAR NORTH acknowledge the Traditional Custodians Page 12 Page 30 Sight-saving surgery in a Healthy Habits for Healthy Women of the land on which huge success Page 31 we work and live, Page 13 Signature Story: Charlie’s Journey to wellness and recognise their Signature Story: Thanks to the eyes! Much Needed Outreach Services in Ravenshoe continuing connection Page 14 Page 32 Provider Profile: Franz Felfer: Sight for the South Provider Profile: An interview with Louise Craig to land, water and West Page 33 community. We pay Page 15 Healthy Hearing for Life respect to Elders past, Upskilling local staff in the South West present and emerging. Provider Profile: Barry Sheehan 4 Outreach Impact

OUTREACH SERVICES CheckUP, in partnership with the Queensland Aboriginal and Islander Health Council (QAIHC), is the jurisdictional fundholder for the Rural Health Outreach Fund (RHOF), the Medical Outreach Indigenous Chronic Disease Program (MOICDP), Healthy Ears – Better Hearing, Better Listening Program, the Visiting Optometrists Scheme (VOS) and the Eyes and Ears Surgical Services (EESS) program, in Queensland.

Collectively, these five programs are known as Outreach Services.

Rural Health Outreach Fund (RHOF) health for Indigenous children and youth for the diagnosis, treatment and management of ear and The aim of the Rural Health Outreach Fund is hearing health. to improve health outcomes for people living in regional, rural and remote locations by supporting The Program’s objectives are to increase access the delivery of outreach health activities. to multidisciplinary care in primary health care settings and to increase the range of services The program focuses service delivery on maternity offered by visiting health professionals to prevent, and paediatric health; eye health, support for detect and manage ear disease more effectively. chronic disease management and women’s health. Visiting Optometrists Scheme (VOS) Medical Outreach Indigenous Chronic Disease Program (MOICDP) The objective of the Visiting Optometrists Scheme is to improve the eye health of people residing The aim of the Medical Outreach Indigenous in regional, rural and remote locations, including Chronic Disease Program is to increase access to Aboriginal and Islander communities. a range of health services, including expanded primary health for Aboriginal and Torres Strait VOS increases access to optometry services Islander people in the treatment and management in areas of identified need and improves the of chronic disease. coordination and integration of eye health services and the quality of ongoing patient care. The MOICDP focuses service delivery on diabetes, cardiovascular disease, chronic respiratory disease, Eyes and Ears Surgical Services (EESS) chronic renal (kidney) disease, cancer and mental health. The Eyes and Ears Surgical Services program aims to improve access to Ear, Nose and Throat (ENT) Healthy Ears - Better Hearing, Better Listening surgery and Ophthalmology surgical services for Aboriginal and Torres Strait Islander people, The aim of the Healthy Ears - Better Hearing, Better prioritising those people living in rural and remote Listening Program is to increase access to a range locations. of health services including expanded primary Outreach Impact 5

Ann Maree Liddy Matthew Cooke CEO, CheckUP CEO, QAIHC

Welcome to edition two of Outreach Many of the stories and articles Impact magazine. Once again we featured in this second edition of are proud to showcase the diverse Outreach Impact magazine focus range of health services that are on some wonderful work being delivering much needed health care undertaken around improving the to Queenslanders closer to home. hearing outcomes for “jarjums” in our communities. In this edition of Outreach Impact we introduce a series of Signature The recently released Queensland Stories, for example, Aunty Venus Aboriginal and Torres Strait Islander from Cherbourg who is now painting again after her sight- Child Ear and Hearing Health Framework 2016-2026 is a ten saving cataract surgery in Roma earlier this year. There is year framework for improving the health, early childhood also a story about the Aboriginal and Torres Strait Islander development and educational outcomes of Aboriginal and children who had long overdue ENT surgery at Noosa Torres Strait Islander children in Queensland. The services Hospital which has markedly improved their concentration being delivered across Queensland, much of it by our own and participation in the classroom. Aboriginal Health Workers, feed directly into producing better outcomes for our people. To the service providers I am sure you will be inspired by these stories, as they who deliver these services and the Regional Coordinators provide tangible examples of how Outreach services are who support these services, ‘thank you’ - your efforts in this making a real difference to the lives of rural and remote field are life changing to the children who receive them. Queenslanders, particularly Aboriginal and Torres Strait Islander families and communities. The Regional Coordinators who work collaboratively across the state have facilitated strategies to target Aboriginal and Our Outreach services could not be delivered without the Torres Strait Islander Queenslanders, many of who present support of many dedicated health care professionals and with complex health problems and it is through mainstream health service organisations from across Queensland, and Aboriginal and Torres Strait Islander Community including the community controlled health sector. Controlled Health services working together, that we are able to remove inequalities in health care, improve access and Special thanks to our partners QAIHC and to the entire provide culturally appropriate services. Outreach team for their tireless commitment and dedication. We look forward to continuing our work together to create a Congratulations to everyone involved in the QAIHC/CheckUP healthier and more equitable Queensland. partnership who work tirelessly to Close the Gap and improve health outcomes for Aboriginal and Torres Strait Islander Queenslanders. 6 Outreach Impact

OUTREACH REGIONAL STRUCTURE CheckUP, in partnership with QAIHC, has established a regional and coordinated approach to planning, delivery and review of structure to support the most equitable, efficient and effective services in each region. The RPCCs are steered and supported by delivery of services within each region across Queensland. the Outreach Regional Coordinator based in the region to enable strong local and regional planning and service delivery that meets Six have been established: Far North, North West, North, the identified health needs of the community. Central, South West and South East. This structure is supported by the role of the Regional Coordinator. The primary purpose of The RPCC oversees the planning and coordination of the regional the Regional Coordinator’s position is to manage and support the services to ensure the services delivered meet identified needs integrated and coordinated planning, delivery and monitoring of and improve health outcomes for people living in urban, regional, Regional Outreach Services. rural and remote locations particularly Aboriginal and Torres Strait Islander Peoples. The Regional Coordinators: • Work with all relevant stakeholders to drive and support the The RPCCs focus on: use of a population health and needs based regional planning • Regional health needs, priorities and corresponding service approach to plan, deliver and monitor services delivered gaps. under Commonwealth funded Outreach Programs. • Workforce supply versus community need and supplementary • Liaise with and provide “on the ground” support for regional resources required. health service providers and key stakeholders. • Local community health trends. • Lead the development of regional service delivery plans that • Priority locations for services. align with identified population health needs. • Appropriate models of service delivery. • Monitor the implementation of Regional Outreach Services to • Local infrastructure and equipment needs. ensure service delivery is culturally appropriate, efficient and • Opportunities to leverage off existing services and program effective. • Service delivery and provider data - uptake and spread of services. Another key component of the structure are Regional Planning • Monitoring and reviewing services to ensure compliance with and Coordination Committees (RPCC) which facilitate an integrated local service schedules.

Central Region: Agnes Waters-Biggenden-Biloela-Blackwater-Buderim--Calliope-Childers-Eidsvold-Emerald-Gayndah- Gemfields-GinGin-Gladstone---Kilkivan-Maroochydore-Maryborough-Monto-Mount Morgan-Moura- Mundubbera-Noosa--Rolleston-Sapphire-Springsure-Taroom-Theodore-Tieri-Wandoan-Woorabinda-Wowan. Regional Coordinator - Anita Williams.

Far North Region: Atherton-Aurukun----Boigu Island--Cardwell-Chillagoe-Coconut Island-Coen- Cooktown-Croydon-Darnley Island-Edmonton-Forsayth-Georgetown-Hammond Island-Hope Vale-Horn Island--Innisfail- Kowanyama-Kubin Island-Laura-Lockhart River- Island-Mapoon--Mossman-Mossman Gorge-Mount Garnet-Mt Surprise-Murray Island-Napranum-Pormpuraaw-Ravenshoe--St Paul’s Island--Tully-Warraber Island- ---Yarrabah-Yorke Island. Regional Coordinator - Moira Matic.

North Region: Airlie Beach-Ayr-Bowen-Cannonvale-Cardwell-Charters Towers-Clermont-Collinsville-Dysart-Garbutt-Greenvale- Hughenden-Ingham-Middlemount-Moranbah-Nebo-Palm Island-Pentland-Proserpine-Ravenswood-Richmond-Sarina-Townsville. Regional Coordinator - Susan Dixon-Grover.

North West Region: Adel Grove-Alpha-Aramac-Barcaldine-Bedourie--Blackall-Boulia--Camooweal-Cloncurry- Dajarra-Doomadgee-Gregory-Isisford-Julia Creek-Jundah-Karumba-Longreach-Mornington Island--- Normanton-Stonehenge-Tambo-Urandangie--Winton. Regional Coordinator - Jessica Silver.

South East Region: Acacia Ridge-Bilinga-Browns Plains-Burleigh Heads-Caboolture-Capalaba-Coolangatta-Deception Bay-Goodna-Goomeri-Inala-Ipswich-Laidley-Logan-Miami-Morayfield-Northgate-Oxenford-Stradbroke Island-Strathpine- Woolloongabba-Wynnum. Regional Coordinator - Sarah Duke.

South West Region: Augathella-Charleville-Cherbourg-Chinchilla-Cunnamulla-Dalby-Dirranbandi-Eulo-Goondiwindi-Gympie- Inglewood-Kingaroy-Miles-Millmerran-Mitchell-Murgon-Oakey-Quilpie-Roma-St George-Stanthorpe-Surat-Tara-Texas- Thargomindah--Wallumbilla-Warwick. Regional Coordinator - Nigel Daisy. Outreach Impact 7 OUTREACH BY THE NUMBERS Statistics for the period July 2014 to June 2015 122,959 occasions of service

156 12,962 locations in visits Queensland

84,997 occasions of 145 service for health Aboriginal & providers Torres Strait Islander patients

70% of visits by 1,266 allied health services providers

The Outreach team from CheckUP, QAIHC and IUIH 8 Outreach Impact

South East Queensland Provider Profile IUIH Audiology Team: Every child, every year

Since audiology was introduced to allied health services Delivering services directly within Aboriginal Medical Services through the Institute for Urban Indigenous Health (IUIH) in means that Aboriginal and Torres Strait Islander patients can June 2014, the team has delivered more than 1,000 hearing access audiology services close to their home with transport assessments to clients aged from six months to 86 years. Over assistance, coordinated primary care, and supporting allied this period, 28.5% of children and 75.9% of adults referred to health services to ensure identification and management of IUIH Audiology had a hearing loss recorded at their first visit. any patient at risk of ongoing hearing loss.

The IUIH was established in 2009 by four independent The IUIH Audiology Team are committed to offering student Community Controlled Health Services to provide for the placements to Masters of Audiology students to allow as many needs of ’s second largest Indigenous population, future audiologists as possible to experience healthcare in and now provides services through 18 multidisciplinary health urban Aboriginal Medical Services and come to understand clinics across South-East Queensland. the needs of Aboriginal and Torres Strait Islander audiology clients. Audiology was identified as an essential allied health service for many urban Aboriginal and Torres Strait Islander clients Future goals for the IUIH Audiology Team include supporting with more than 65,000 living in the all clinics in the IUIH network to provide a hearing screen to South-East Queensland corner which represents one-third of every child, every year. Queensland’s Indigenous population.

Starting with one part-time audiologist in mid-2014, the IUIH Audiology Team has now grown to 2.3 full-time positions currently filled by three audiologists – Nuala Beahan, Patrice Johnson, and Kristy Moore. The IUIH Audiology Team provide services in 16 IUIH clinic locations in South-East Queensland as well as providing an outreach service to clients in Hervey Bay.

The IUIH Audiology Service and the IUIH Speech and Occupational Therapy Services are subsidised by Healthy Ears Outreach funding. The full cost of these services require reinvestment of Medicare income generated through the IUIH network of primary health care clinics, with a goal of early detection, management and prevention of the negative impacts associated with recurrent and persistent middle ear disease. Joint ENT and audiology clinics are currently provided IUIH Audiology Team celebrate their first 1,000 hearing tests with the in two IUIH locations with visiting ENT specialists. IUIH allied health director Dr Alison Nelson. Pictured from left to right are Kristy Moore, Dr Alison Nelson, Dr Nuala Beahan, and Patrice Johnson. Outreach Impact 9 Signature Story Brighter futures at the Murri School The Aboriginal and Islander Independent Community School (hereafter referred to as the Murri School) in Acacia Ridge was first established in 1986 with an aim to promote the development of Indigenous students as independent and skilled people who are culturally, morally and socially responsible, employable, capable of self-fulfillment and of contributing to society.

Families at the Murri School are finding it easier to access have also liaised with ENT services at the Logan Hospital health services for their kids through the local school to ensure that Alice was able to access medical treatment community thanks to a partnership between the school, the (including adenoidectomy and bilateral grommet insertion), Institute for Urban Indigenous Health (IUIH), the and the IUIH Audiology Team have provided regular Aboriginal and Torres Strait Islander Community Health monitoring of her hearing. Alice was also assessed by the IUIH Service and the Outreach program. Optometry Team who found that her vision is within normal limits and she does not require glasses. The IUIH allied health service at the Murri School is an integrated service that links with the school community and Alice’s teacher recognised that she also needed some extra the on-site medical centre. The team consists of audiology, support at school and linked her with speech and occupational optometry, physiotherapy, speech pathology, occupational therapy services. She has received support from the speech therapy, exercise physiology, podiatry and dietetic services. and occupational therapists to develop her hand skills, increase her classroom participation, improve her speech and This integrated approach facilitates smooth communication language skills and to facilitate literacy development. between all those involved with a family and allows therapy and school programs to work closely together to support each Alice’s classroom teacher and other school staff have reported child. good improvements in her ability to focus and in her speech and language skills which has helped her to participate more For example, Alice* a student at the Murri School, has a history fully in the classroom and improved learning outcomes. Alice’s of chronic middle ear disease and conductive hearing loss. future is looking bright as she will continue to receive the support she needs with all services working together to meet She has received ongoing support from the CheckUP funded her learning goals and health needs. ENT specialist who visits the medical centre, and the IUIH Audiology Team. Staff from the Acacia Ridge Medical Centre * not her real name

Students from the Murri School 10 Outreach Impact Signature Story Meet Leslie Beckett, a Murriwarri man

Leslie Beckett is a Murriwarri man who attends the Kambu Les added, “I would like to learn some vegan recipes and learn Medical Service in Ipswich. In December 2014, Shirley Van Der how to cook healthier meals. I’m finding it really exciting. I’m Linde, a credentialed diabetes educator, met Leslie to help him on a new path now. It’s enlightened me but that’s really thanks better manage his type 2 diabetes. to Shirley and the other people involved in diabetes at Kambu Health Service.” “When I first met Leslie his concerns were hypoglycaemic (hypo) events, getting his HbA1C below 8% and he wanted to The collaboration and integration of the Outreach funded lose weight. Les also struggled to get up specialist and allied health services at from his chair due to pain in his knees the Kambu Clinic in Ipswich has helped that had worsened due to an increase Leslie achieve a great deal and Leslie is in his weight. Les had also stopped particularly pleased that he: self-monitoring his blood glucose levels • Has started using a lancet device because he did not like pricking his which makes taking blood glucose finger as it was too painful,” Shirley Van levels less painful. Der Linde recalled. • Has learnt more about the relationship between carbohydrate After a few appointments with Shirley, intake and blood glucose levels and Leslie noticed some immediate the importance of monitoring blood improvements, and commented, “Shirley glucose levels. managed to change the lancet device for • Has lost 8kg and 9cm off his waist. pricking my finger to a much less painful • Increased his physical activity levels. one and she helped me to change my Les is more active at home and takes thinking; helping me understand the short walks in the shopping centre. importance of taking my blood sugar”. • Is using his sleep apnoea machine regularly. “I was always worried about my hypos. I • Has reduced hypoglycaemic events. was frightened so I would eat more carbs • Has less painful knees and can get in but I’ve realised now how to judge the amount of carbs I eat and out of his chair more easily. and how much insulin I need. My life is a lot smoother now. My insulin intake is lower and my food intake is really good The integrated team approach to Leslie’s health has also because I’m not being silly with my diet.” allowed for the cardiologist, endocrinologist, general practitioner and diabetes educator to collectively discuss “Les feels more in control of his blood glucose levels and is Leslie’s diabetic medication and recommend alterations as planning to learn some new recipes from the dietitian and he needed. will return to the Kambu Exercise Program when he is injury free,” Shirley Van Der Linde said.

“My insulin intake is lower and my food intake is really good. I’m finding it really exciting. I’m on a new path now.” Outreach Impact 11

Partnership Providing Clear Sight for Queenslanders Aboriginal and Torres Strait Islander people from across the whole experience welcoming and smooth for patients. are seeing more clearly following • Moreton ATSICHS Deception Bay Clinic hosted the pre- vital cataract surgery. The surgery was provided through an and post-operative assessments. Clinic staff went to Institute for Urban Indigenous Health (IUIH) and Peninsula great lengths to ensure that patients and carers were Private Hospital partnership supported by Outreach Eyes and comfortable, well cared for, and organised. Ears Surgical Services funding. • Zeiss Instruments generously loaned the use of an IOL Master, an essential instrument used in pre-operative Loss of vision due to cataracts can be debilitating for the measurements for cataract patients. It was installed in patient and their family, having a huge impact upon quality of Moreton ATSICHS Deception Bay Clinic, meaning that all life. The lens in the eye becomes cloudy, reducing visual acuity, pre-operative assessments could be done in one visit. colours become dull, and glare can be unbearable. Often • The Fred Hollows Foundation, a longstanding partner of people find their vision blurs to the point where they can no IUIH, provided funding for the purchase of the intraocular longer safely drive which affects employment and family life. lenses for surgery and funded the use of a videographer Chronic disease, especially diabetes, increases the likelihood to film the project. of cataracts developing. Cataracts can also obscure the view • IUIH Home Support (aged care services) was instrumental of the back of the eye, so health professionals can no longer in providing transport, and organised a BBQ for patients monitor the development of serious retinal eye disease such and carers who stayed overnight after surgery. as diabetic retinopathy, risking permanent loss of vision. • Redcliffe Motor Inn provided affordable accommodation, with staff who were friendly, welcoming and helpful to Cataract surgery is quick, safe, and highly successful in patients and carers after a long surgical day. restoring clear vision almost immediately. However, public cataract surgery waiting lists are long, and the barriers to Since establishing the South East Queensland Regional Eye accessing these public surgical services for many Indigenous Health Program (REHP) in 2014, IUIH has expanded eye patients can be significant. services to 15 clinics across the region, employing four full time optometrists, and incorporating two visiting ophthalmologists Patients accessing eye health services in IUIH clinics across funded through the Medical Outreach Indigenous Chronic South East Queensland were prioritised for surgery based on Disease Program. Each month around 400 patients access eye the extent of vision loss and factors affecting the impact of health services across the region. vision loss such as co-morbidities, social circumstances, and other physical and mental health considerations. Provision of the Outreach Surgical Services funding has allowed IUIH to overcome many of the traditional barriers IUIH ophthalmologist Dr Katherine Smallcombe conducted the that Indigenous clients in South East Queensland face when surgery at Peninsula Private Hospital with post-operative care accessing cataract surgery, and has resulted in the restoration and support being provided by the IUIH optometry team. This of vision for 32 Indigenous Australians’ eyes throughout support was delivered via telehealth, thereby reducing travel the region. By utilising services available through the IUIH times for the patients. network and programs, and capitalising on partnerships and relationships with other organisations, the cataract surgery Partnerships and collaborative relationships with many pathway was coordinated in a cost and time efficient manner. organisations were a key to the success of the cataract surgical project: Importantly, this coordinated pathway occurred, as much as • Healthscope and Peninsula Private Hospital (PPH) possible, ‘under-one-roof’ and in partnership with the familiar partnered with IUIH, ensuring access to surgical facilities in staff of the client’s local health clinic. a comfortable environment. The caring staff at PPH made 12 Outreach Impact

South West Queensland

Sight-saving surgery in South West Queensland a huge success Aboriginal and Torres Strait Islander possible by a one-off grant from the Special thanks to the South West people have had sight-saving cataract Australian Government to CheckUP Hospital and Health Service Executive surgery at Roma Hospital through a for eye and ear surgery for Aboriginal and surgeon, Dr Steven Rodwell for large collaboration of health services in and Torres Strait Islander people in their role in facilitating the surgery South West Queensland. Queensland. at Roma Hospital, and the Aboriginal Medical Services who played a critical During three days of operations in CheckUP and QAIHC are planning for role. Thanks also to the IDEAS Van and February and March 2016, almost 60 more “cataract surgery blitzes” in other Dr Rowan Porter, who provided services patients from South West Queensland parts of rural and remote Queensland from the van and prioritised patients for had surgery in an exercise made over the next 12 months. surgery.

Patients after their cataract surgery Outreach Impact 13 Signature Story Thanks to the eyes!

Aunty Venus Rabbitt is an artist and storyteller who lives in paint. Going to Roma and getting my eyes done has made Cherbourg. Her father was a storyteller and a big difference. I can see bright, bright colours now and she learnt her storytelling and artistic skills from him. it’s wonderful. I must have done about six paintings when I came home and it was wonderful. The staff at Roma About a year ago, Aunty Venus started having trouble Hospital were really nice. You can’t ask for better doctors. seeing clearly due to cataracts on her eyes. She was They make you feel comfortable”. referred to the IDEAS Van from the Cherbourg Regional Aboriginal and Islander Community Controlled Health When CheckUP staff visited Aunty Venus at her home in Services for an assessment. Aunty Venus was then Cherbourg one month after her surgery, she was working referred for cataract surgery at the Roma Hospital as part on a new painting, Kangaroo Dreaming (pictured above), of the CheckUP funded surgery blitz which saw almost 60 that depicts her father, grandfather and great grandfather. Aboriginal and Torres Strait Islander patients have cataract surgery during three rounds of surgery. “These three men mean a lot to me because they’re strong and they encouraged me with everything. People say I’m Aunty Venus is delighted with the results. “Before the blessed with my art. It really means a lot to me. I’ve come surgery I couldn’t see properly and it was confusing to a long way from drawing stick men with my grandfather”.

“Before the surgery when my sight wasn’t good I used to just paint with browns but since the surgery I can now paint with bright colours. Pretty deadly, hey! Thanks to the eyes!”

Aunty Venus Rabbitt 14 Outreach Impact Provider Profile

Franz Felfer: Sight for the South West

Optometrist Franz Felfer has been a part of communities in South-West Queensland for 30 years. Franz lives in Ipswich and travels to the South-West region regularly. He is a highly experienced optometrist and has a very good understanding of eye health needs in the area.

Under the Visiting Optometry Scheme (VOS), Franz works with many communities from Dirranbandi, Inglewood, St. George, Surat and Texas. Working closely with Goondir Health Service which is based in St George, these much needed optometry services are reaching the Indigenous population in an area where almost half of the total patients seen across these communities identify as Aboriginal and/or Torres Strait Islander.

“The South West Queensland communities have been through a lot of tough times over the last decade. We’ve seen the extremes of floods and droughts and it’s really amazing to see the resilience the communities show. Individual health sometimes gets put on the back burner during the tough times, so it’s really important that regular Outreach visits continue.” Outreach Impact 15 Upskilling local staff in the South West Dr Christopher Danesi provides Outreach psychiatric Danesi to share his years of knowledge and experience. services to residents of Roma and Charleville in South West Queensland. This extremely important service The upskilling sessions have been helpful in reviewing allows a range of people, who otherwise would be many topics and have lead to interesting discussions unable to access psychiatric services, to be assessed. on patient management, as well as giving staff the confidence to successfully manage their patients Dr Danesi has specialised in the provision of services between Dr Danesi’s Outreach visits. to those who have PTSD at his Currumbin Clinic for the last 18 years. Being in private psychiatric practice means On most Outreach visits two medical students that those with anxiety, depressive disorders, alcohol accompany Dr Danesi, hoping that exposure to rural or drug dependence, and adult ADHD are commonly Australia will inspire them to work in these locations in reviewed. Dr Danesi brings decades of experience to the the future. development of mental health management plans which can be life-changing for many patients.

“I worked in general practice for six months before embarking on further psychiatric training, thinking it would not be that hard to get a handle on psychiatric conditions. However, it took me many years to get a thorough understanding of the complexities of mental health issues that people experience”.

In view of this, Dr Danesi saw the importance of upskilling GPs and providing educational sessions to health professionals in Roma and Charleville. These On the left is Dr Ian Kettle the pilot, and on the right is another GP, Dr sessions are structured so the local staff are given the Doug Warne from Murwillumbah who accompanied Dr Danesi on a opportunity to freely ask about any topic and allow Dr visit to Roma and Charleville. Provider Profile Barry Sheehan With escalating figures surrounding mental Visits to Oakey currently average six patients health issues continuing to be of major per visit, with 55% Aboriginal or Torres Strait concern in the South East Queensland region, Islander. Barry Sheehan Psychology and Consultancy believes an improved relational dialogue With more than 25 years’ experience as a approach between patients, GPs and other psychologist, and in managing Government allied health service providers is key to and non-Government agencies throughout improving health outcomes for people living regional and rural Queensland, Barry has in regional, rural and remote locations. developed a strong passion for rural and Indigenous mental health and adopts Over the past year, Barry Sheehan has a person-centred, holistic approach to conducted a total of 40 circuit visits on behalf psychology. of CheckUP Outreach Services, consulting with a number of patients in both Dalby and Working closely with the health professional Oakey. team at Goondir Health Services, Barry is committed to removing the stigma often On average, Barry sees nine patients during Barry Sheehan associated with seeking the service of two-day, weekly visits to Dalby, with 71% mental health programs. Aboriginal or Torres Strait Islander. 16 Outreach Impact

Central Queensland Reducing wait lists in Blackwater

Blackwater is situated in Ghungalu Country, approximately 200 a noticeable decrease in the waiting list and many clinical days kilometres west of Rockhampton. Blackwater is a major coal have no vacant appointment slots. mining town in the region and has a population of just over 5,000 people. There is an exemplary working relationship between the Blackwater MHS clinical team and the psychology service Distance, drought and a culture of self-reliance are among provided by LTTS. The spirit of collaboration also extends to some of the issues facing people living in rural and remote the Blackwater allied health team with many referrals made Queensland, and this is also the case in Blackwater. Through by the LTTS psychologist to the occupational therapist and consultations with local health providers it was determined speech pathologist that provide services at the same clinic in that there was a high need for psychology services in the town. Blackwater.

Lifestyle Therapies and Training Solutions (LTTS), in Feedback from Blackwater residents has been very positive partnership with Blackwater Multipurpose Health Service with many highlighting high levels of satisfaction with the (MHS) and Outreach Services, have been coordinating and support they have received from the LTTS psychologist and delivering psychology services to the residents of Blackwater other health providers in the town. since July 2015.

When the service began, the wait list was extensive and many patients regularly failed to attend appointments, thereby exacerbating the wait list problem . In consultation with LTTS, the clinical team at Blackwater MHS developed an ‘on the day waiting list’. This means that if patients do not arrive or cancel their appointment, another patient on the list is contacted and invited to attend the vacant appointment slot. This process allows new clients to access the service more quickly and for crisis patients to be seen almost immediately.

Since the implementation of this new system, there has been Blackwater Mine Outreach Impact 17 Signature Story ENT Surgery at Noosa Hospital A collaboration between CheckUP, the for Community Health, and the Noosa One parent, Jodie Vibe from Eudlo, AMAQ Foundation, Ramsay Health Care, Hospital and ENT surgeon Dr McIntosh commented that her seven year old son Dr David McIntosh and the North Coast were quick to get on board knowing that Nicholas had been having hearing issues Aboriginal Corporation for Community the surgery would have an immediate which were picked up by his teacher. Health has paid dividends for 15 impact on the children’s overall health Nicholas had his adenoids removed and Aboriginal and Torres Strait Islander and well-being, as well as their learning his ear drum drained by Dr McIntosh. children who had a variety of ENT at school. surgical procedures performed at the Jodie said that, “We are so grateful that Noosa Hospital in early March 2016. Following the long day of surgery Dr we were able to get Nicholas in for McIntosh reflected that many of the surgery so quickly. He’s just started at The funding was generously provided children had been experiencing trouble a new school so having this problem to CheckUP by the AMAQ Foundation with their sleeping, breathing, hearing, fixed is really important to help him and was put to good use by fast- behaviour and concentration. integrate into his new classroom and tracking surgery for these children who make friends. Nicholas always talks a would have otherwise waited more Dr McIntosh said, “It’s a great few decibels louder than everyone else than a year to have their health issues opportunity that we’ve been given today so the surgery today will make a big addressed through the public system. thanks to the support of CheckUP and difference to his life and learning”. The surgeries included tonsillectomies, the AMAQ Foundation. We’ve managed adenoid removal, tongue snips and the to get a lot of kids through surgery today CheckUP CEO, Ann Maree Liddy, is insertion of grommets. and get them fixed in a far timelier delighted that so many children were manner than otherwise would have able to have their hearing issues The children’s health assessments been possible. The parents are thrilled addressed all at once, and is very were undertaken by health workers and the kids are recovering well”. thankful to the AMAQ Foundation for at North Coast Aboriginal Corporation funding this important initiative.

Dakota, 9 Cecily and Kenneth, 4 Nicholas, 7 with his parents

“Without the AMAQ Foundation funding, this wonderful initiative would not have been possible. It’s the second round of ENT surgery that’s been undertaken at the Noosa Hospital following surgery on another 21 Aboriginal and Torres Strait Islander kids in June 2015. We know there are more children around Queensland on long waiting lists for ENT surgery so we’re looking forward to partnering with AMAQ Foundation again in the future so more children will benefit”. Ann Maree Liddy, CheckUP CEO 18 Outreach Impact

Team approach making a difference in Gladstone Gladstone is approximately 550 The long wait list, in conjunction with In addition, the existing drug and alcohol kilometres north of Brisbane with a the Outreach needs assessment, lead counselling service in the region also population of 32,073 of whom 4.2% to a conversation between Dr Ryan, started collaborating with the mental identify as Aboriginal and/or Torres the practice manager at Nhulundu and health team, and now co-locates with Strait Islander. The CheckUP’s Regional Coordinator in early the team at Nhulundu. is home to the Gooreng Gooreng 2015. It was identified that the clients (pronounced goor-RENG goor-RENG), on the waiting list would greatly benefit, The new outreach mental health team Gurang (goo-RANG) and Bailai (BAL-ai) and be seen in a more timely manner, if of nurse, psychiatrist, psychologist, and Aboriginal tribes. they had the support of a psychologist, drug and alcohol counsellor at Nhulundu mental health nurse and drug and is producing some very positive Psychiatrist Dr Leo Ryan began outreach alcohol counsellor. outcomes for the Aboriginal and Torres visits to the Nhulundu Health Centre Strait Islander people in the Gladstone located in South Gladstone in 2012. The After a short recruitment process, Ed region with a much shorter waiting list, service was desperately needed however Mosby (psychologist, pictured above) significant improvements in follow- the demand was so great it resulted in and Lyndell Ilka-Chittick (mental health up care and more effective handover long waiting lists for an appointment. nurse) were engaged to be part of the processes. outreach mental health team. A message from a patient... My name is Janienne and I have been a type 1 It was a common occurrence for me to see a Through fortnightly visits to the diabetes clinic diabetic for 18 years. I developed this disease new doctor and explain the workings of my at There4U and with the support, knowledge, as a result of contracting a virus when I was insulin pump to them. encouragement and determination of about 23 years old. Carolanne and Dr Russell I have been able to I first met Dr Louise Russell and diabetic reduce my HBA1C to the lowest level it has Living in a rural town with type 1 diabetes and educator Carolanne Boland at There4U after ever been! managing my condition with an insulin pump, my insulin pump broke down at about 10pm it can be difficult to find the support and one night. Through this meeting I discovered Their knowledge of this disease and knowledge required to assist in managing this that Dr Russell had a fantastic working treatment options means that I have access condition and also find someone who knows knowledge of insulin pumps and could to up-to-date information and ongoing care how to work an insulin pump. interpret the graphs and results from the without leaving town or having to explain information I entered into the pump. myself to a new doctor each visit. I am very Previously I was relying on my annual visits to thankful for their patience and support. Brisbane with my endocrinologist to manage I also realised that my diabetes wasn’t as well my pump settings as I hadn’t met anyone else controlled as I thought it was! Janienne Yates who knew how to use one. Outreach Impact 19

Provider Profile Michael Young Optometrist Michael Young is “In 2002, we were having dinner with Queensland. The people in this region passionate about eye health. a family friend who was the local GP in are fantastic to look after. I particularly This is his story. Biggenden in , and enjoy working with Indigenous people - he invited me to visit his rural practice getting to meet the families, the children, “I grew up in regional New Zealand and one day. That trip to Biggenden was the and the Elders is a privilege. I am graduated as an optometrist from the catalyst for my love of working in the committed to doing my best to ensure University of Auckland in 1985. Shortly country. I especially love the stunning that everyone in my patch has the best thereafter, I met my Australian wife- natural environment, and the wonderful eyesight that I can provide. My mission to-be Lyn, a nurse, and we relocated patients”. to ensure that there are no children with to Melbourne so Lyn could further her uncorrected amblyopia (lazy eye) out nursing studies. After 12 wonderful “We sold our Brisbane practice and there that I have missed”. months in Melbourne, working with a purchased some country runs from diverse, multi-cultural community Lyn retiring optometrists. Biggenden “The funding that is received from decided to become an optometrist so we soon expanded to Gayndah, then to CheckUP greatly assists with being able packed up again and moved to Brisbane Mundubbera and Eidsvold”. to travel throughout this part of the so Lyn could undertake her studies at state, and helping as many people as QUT. For the next 15 years, we worked “Now in 2016 we have over 20,000 possible to improve their eye health. as optometrists in Brisbane”. patients on our books and are visiting Essentially, I would not be able to do even more locations throughout Central what I do without this support”.

Michael Young with Aboriginal Elder Oscar Chapman 20 Outreach Impact

Improving health and well-being in Woorabinda Jaime Parnell (pictured) is a environment, playing a critical psychologist who provides social role in assisting the community of and emotional well-being services Woorabinda. to the community of Woorabinda, a small town of almost one thousand Jaime not only works very closely people 170 km south-west of with the Special Education Rockhampton. Department within the school but also the visiting paediatrician, Woorabinda is situated on the Dr. Sunday Pam from the Central traditional lands of the Wadja Queensland Hospital and Health Wadja/Yungulu Aboriginal people. Service, and she has established Jaime provides her service at the great referral processes between the local primary school and the Multi- two services. Purpose Health Centre. so that the strategies can continue Jaime’s social and emotional well- Jaime engages with the children to be implemented and reinforced in being service has also played a by using a story-telling approach the home environment. pivotal role in establishing links with while integrating behavioural the visiting speech pathologist with interventions focused on emotional Jaime’s role has evolved to focus on many students identified so far who regulation. These are very practical an early intervention approach with have been referred to the speech strategies and Jaime also involves the children and she has now firmly pathologist. family members during the sessions cemented herself in the school Outreach Impact 21

The Woorabinda team Working together in Woorabinda to make a difference CheckUP, in collaboration with the Central allows the community to have the assurance Queensland, Wide Bay and Sunshine Coast that their allied health needs can be met in Primary Health Network (PHN), initiated a one clinic, at one time, on a regular basis. review of services delivered in Woorabinda. A key factor to the success of the clinic is the Previously, a lack of engagement and utilisation of employment of a care coordinator, who lives in health services by the community demonstrated the community and is funded by the PHN. The that a more coordinated, multidisciplinary care coordinator supports the clinic by liaising approach was needed, with the aim of improving with clients, the community stakeholders, books health care access by centrally locating multiple appointments and addresses challenging issues allied health professionals. such as contacting people who fail to With this in mind, the PHN attend appointments. and CheckUP successfully collaborated to develop The collaborative a team approach to allied approach at Woorabinda health services and the extends to the Australian first multidisciplinary Red Cross who have clinic commenced agreed to support the in November 2015. clinic by collecting clients who are not able to attend This new, successful the clinic independently. model now provides a fortnightly clinic which

Picture on facing page: Woorabinda Dancers - Copyright Kerry Trapnell and Laura Dance Festival http://www.kerrytrapnell.com 22 Outreach Impact

North West Queensland

Provider Profile Dr Claire Barrett

Dr Claire Barrett is an Outreach rheumatologist based in “I sometimes ask myself, does such specialist care make a Redcliffe, just north of Brisbane. As part of an initiative to difference? I was pleased to find that a recent audit showed improve access to rheumatology specialist care for those that since the rheumatology outreach clinics were established, Queenslanders who do not live in the south-east corner of the patients with rheumatoid arthritis have had a significant state, she visited Longreach in September 2012 to meet with reduction in the level of their disease activity which is local health providers. associated with better long term outcomes in terms of quality of life and disability”. Claire met with Longreach GP, Dr David Walker who highlighted the challenges faced by patients with diseases such Claire comments that, “The medical staff at the Longreach as rheumatoid arthritis who live a considerable distance from Family Medical Practice have been amazingly supportive, expert care. and the patients are extraordinarily grateful for the time and money saved on travel to Brisbane”. Claire reflected on that meeting, “It was great to hear first- hand about the problems facing patients in regional areas. It is hoped the initiative to offer access to such care can be After hurdling a few issues along the way, a quarterly visiting replicated in other regional and rural areas in Queensland. service commenced in May 2013. It’s now three years later, The Australian Rheumatology Association (ARA) has made and 10 clinics have been held and 78 new patients have been improving access to specialist care for regional patients seen with nearly 150 face-to-face appointments and hundreds with rheumatic disease a priority and based on Dr Barrett’s of telehealth follow-up consultations with patients”. Outreach visits to Longreach, the service is proving to be highly beneficial for patients. Outreach Impact 23 Pain management in North Queensland The North Queensland Persistent Pain • An efficient patient triage and flow University teaching for Management Service (NQPPMS) consists process, beginning with a self- physiotherapy, psychology, of 35 staff (pictured) based in Townsville, management, multi-disciplinary occupational therapy, nursing and Mackay and Cairns. The service provides education and motivation workshop medical students. patient education, multi-disciplinary in line with contemporary models • Integration with registrar teaching patient assessment and management, elsewhere. for general practice, anaesthetics, telehealth, group programs and • Recruitment and retention of a full rehabilitation medicine, palliative interventional procedures for people multidisciplinary team, spread over care medicine and emergency throughout North Queensland. three Hospital and Health Services. medicine. • Integration with the Townsville Staff include pain medicine Acute Pain Management Service. specialists and registrars, addiction • A successful roll-out of multi- medicine, psychiatry, rehabilitation disciplinary health professional medicine, neurosurgery, nursing, workshops in Cairns, Mackay, physiotherapy, psychology, Mount Isa and Townsville, with occupational therapy, pharmacy approximately 400 participants, and administration. giving strongly positive feedback. • The presence of a great team with a The team receives over one strong work ethic and high morale. thousand referrals each year, and provides approximately 500 The full multi-disciplinary team has occasions of service each month. been visiting Mount Isa every six Services are provided face-to-face in • Outreach services to Cairns, Mackay months since 2012 and includes a clinical Townsville; by satellite staff in Cairns and and Mount Isa. nurse, physiotherapist, occupational Mackay; via outreach to Cairns, Mackay • The development of a locally therapist, psychologist, registrar and and Mount Isa; and via telehealth to appropriate pain management pain medicine specialist. people throughout North Queensland. program. • Accreditation to train pain medicine In between visits, patients travel to The key achievements have included: specialists. Townsville for interventional procedures, • The development and • Provision of the full range of medical and are seen via telehealth as required implementation of an innovative procedural pain management by the whole range of team members, and locally appropriate model of interventions. many of whom are pictured above. care. • Integration within James Cook Deadly Ears on Mornington Island The Deadly Ears program is ’s statewide The Mornington Island Primary Health Care team are a very Aboriginal and Torres Strait Islander ear health program for strong, determined and cohesive team that really connect children to manage and reduce the high rates of conductive with the community in which they live. Everyone in Edwin’s hearing loss attributable to otitis media. The team engage and team has the same goal - to create a well-run, well-attended consult with communities to deliver a service focused on long community health service. Historically, Mornington Island has term improvement of ear health outcomes for children and had a high turnover of staff however the current staff seem their families. very keen to stay.

The Deadly Ears team are working closely with Edwin Fama, Another success story on Mornington Island are the Child clinical nurse consultant at the Mornington Island Primary Health Team from RFDS Cairns who have achieved 100% Health Care Centre, who leads a multidisciplinary team vaccination rates as well as keeping a close eye on ear issues in committed to ensuring that those who need to see the visiting any of the children they see in their clinics or when they attend Deadly Ears specialists do actually attend their appointments. the school. Edwin is determined that the local community make full use of all visiting medical services. The RFDS team also educate the Emergency Department team at the local hospital to check children’s ears, especially if the Together with his team, Edwin devised appropriate scheduling child presents with a fever. They also send referrals through for the health clinics so that people had ample opportunities to for ENT specialist review with the extremely thorough referrals attend appointments, which included extending the operating containing all the details the Deadly Ears team require. hours until pm. This initiative means that now more people are attending appointments than ever before. Together, the health teams that provide services to Mornington Island are working extremely cohesively and Edwin also has very strong views on ensuring that his team are effectively, and they are all excited about the great things that educated about community health issues and the team have will be achieved for the Mornington Island community over the worked incredibly hard and are dedicated to learning as much next 12 to 18 months. as they can. 24 Outreach Impact Signature Story Doris turns her life Cooking up a around storm in Boulia Doomadgee, an Aboriginal community in the , Boulia is a remote town in Central Western is 100km west of Burketown. It was named after Dumaji, a Queensland with a population of just over 200 people. sandy coastal mound in the land held by the Gananggalinda people. The traditional homelands of the Gangalidda and In response to a growing problem with diabetes in the town, the people lie in and around the Doomadgee Shire. a Diabetes Awareness Group was established by Jillian There are also Garrawa and Yunjulla people and a range of Dray (dietitian) and Angela Martin (diabetes educator), with people from Indigenous nations across Australia have made support from Debbie Lowe and Suzie DalleCourt (Strong Doomadgee their home. Families support workers). The group has gained great momentum over the past few months. Doris*, a resident of Doomadgee, has been seeing the visiting Outreach podiatrist and dietitian regularly and over At the Diabetes Awareness Group meeting in February, 15 the past few months has seen an enormous improvement in people attended along with their 10 children. Five people her diabetes. arrived early to help the dietitian prepare for the cooking class in the kitchen. They brought along a kangaroo tail When the allied health team first met Doris, they were and made a kangaroo tail stew for the group, as well as the concerned that she was at high risk for developing diabetic chicken casserole recipe that was originally planned for the foot ulcers. After a health scare earlier in the year, Doris session. These clients had amazing cooking skills! became highly motivated to control her diabetes and was glad she had come to know and trust the North and West Following the cooking class, many clients had questions Remote Health providers who could help and support her. about healthy eating and dietary control of type 2 diabetes and took information sheets that were provided. With the support of the allied health team, Doris turned her health and life around. She began participating in exercise The Boulia Primary Health Centre continues to support the on a daily basis and she removed soft drink from her diet. group and the senior Aboriginal health worker regularly Doris also introduced more bush foods into her diet, and attends meetings. The Boulia Council provides support by now she regularly attends the clinic to pro-actively seek out advertising the Diabetes Awareness Group meetings on services and remains in close contact with the dietitian and their Facebook page. podiatrist. Groups such as these take a lot of organising so it is very In the last three months Doris’ HbA1c, which is a measure of rewarding to receive so much support from the local her blood sugar, has almost halved. Doris is now compliant community and the allied health staff in the town. It is also with her medication and is also making better, healthier food extremely pleasing to witness high levels of enthusiasm choices. As a result, her poorly controlled type 2 diabetes is from the group members who are working towards now under control, and Doris feels much more in control of improving their self-management of diabetes. her life.

* not her real name Outreach Impact 25

“The service works so well because we work closely with, and depend on, the local GPs. We make it a priority to support and enhance the local workforce through the provision of education and training, and the implementation of eye screening programs. In addition, we provide support using telehealth, which is used primarily for emergencies and reviews throughout the year”.

Innovation Eye Health Team in Central West Queensland Dr Bill Glasson (pictured) for glasses and the has been delivering an ophthalmologists, in ophthalmology service conjunction with the local to the Central West for GPs, perform cataract the last 25 years. Over surgeries and skin cancer that time he has worked related eye excisions. Post- closely with the recently operative care is provided retired ophthalmologist, by the GPs who have been Dr Dennis Stark, the upskilled by Dr Glasson. new ophthalmologist, Dr If spectacles are required Todd Goodwin and the after surgery, they are longstanding optometrists, provided on Geoff’s next Geoff Fitzpatrick and Rowan visit to the region. Churchill. This model helps to Dr Glasson’s team also strengthen the role of the includes two medical GP as the primary care students and an provider for the patient administration assistant as well as significantly who visit the Central West reducing the financial and over three circuits throughout the year. Communities social burden for patients who otherwise would have to they visit are Longreach, Barcaldine, Blackall, Winton, travel long distances for this treatment. Birdsville, Bedourie and Boulia. Due to this collaborative, innovative Patients seen in Longreach are model of care which involves two assessed based on referrals made Hospital and Health Services, two by the optometrists during earlier private specialists and two private outreach visits, and the local GPs. optometrists, there is now a much The ophthalmologists assess the shorter waiting list for surgery in the abnormalities identified and if required, Central West. diabetic retinopathy laser surgeries are completed locally. For more complex With a well-established model like procedures, patients are referred to this, Dr Glasson has worked hard to Longreach for surgery. ensure that succession planning is in place, which is reflected by the recent On surgical days in Longreach, Geoff appointment of Dr Todd Goodwin to Fitzpatrick does all of the refracting the team. 26 Outreach Impact

North Queensland Signature Story Lifestyle change leads to wellness and weight loss

Northern Australia Primary Health‘s like exercise. Through discussion, they Upon review two months later, David exercise physiologist, David Stringini, is identified ways to increase physical was thrilled to see that Alfred had part of a team of multidisciplinary allied activity, whilst avoiding regimented decided to come and see him at the health professionals (pictured) providing exercise plans. hospital rather than opt for a home outreach services to Ayr, Bowen, visit. He reported a weight loss of five Cannonvale, Cardwell, Charters Towers, kilograms and a noticeable improvement Clermont, Collinsville, Dysart, Home in self-esteem. Hill, Hughenden, Ingham, Proserpine, Middlemount, Moranbah, Richmond and Alfred was now happy to take his Sarina. wife out of the house and had even incorporated a daily walk around the Recently David worked with a patient block where he would push her in her called Alfred* who presented with wheelchair. It was also noted that it was obesity and type 2 diabetes. much easier to manoeuvre his wife now with new found strength and improved During the initial consultation, David functional capacity. learnt that Alfred had been physically inactive for more than five years and All of the physical activity options had a suffered from intermittent periods of positive effect on him and after seeing depression. Motivation was low and Examples included pushing his wife’s improvements, it provided him with the he lacked the self-esteem to be seen wheelchair around the backyard while motivation needed to consider planned outside of his high-set house. watering the plants; taking the stairs exercise. Alfred is now comfortably instead of the hydraulic lift; walking to walking 30 minutes twice a week and In addition to his health issues, Alfred the corner store for supplies instead visits the local pool once a week for a is the full-time carer for his wife who is of driving and hanging clothes to dry one hour hydrotherapy session. confined to a wheelchair. The motivation instead of using the dryer. to seek help came when he realised Alfred stated that he has not felt this his biggest fear was not being able to David suggested that Alfred leaves the happy for a long time and consequently continue looking after his wife. wet clothes in the washing machine and his wife gets so much more satisfaction individually take the items and hang out of her day as well. David’s true challenge was finding ways them up on the line before returning to to increase activity for a man who didn’t the washing machine. * not his real name Outreach Impact 27 Provider Profile Queensland doctor hits the road to tackle obesity epidemic North Queensland gynaecologist “We find ourselves sitting on one side On the way, he and his support driver, and Outreach provider, Dr Bill Boyd, of the consulting desk talking to people Des Burgess, visited a number of the is encouraging his fellow health who’ve got obesity problems, and if regional towns dotted along the Bruce practitioners to get out from behind we look as if we’re not particularly fit Highway and spoke with locals. their desks and lead the kind of fit and ourselves the message doesn’t ring healthy lifestyle they preach to their true,” he said. “Obesity, diabetes, cardiovascular patients. disease, high blood pressure, and the “It’s all very well sitting around and increasing damage to hips and knees are Recently the Australian Medical talking about these things but in the end all important topics to talk about.” Association Queensland (AMAQ) you’ve got to get up on your hind legs launched its Walk the Talk campaign, and actually do something. There are no Dr Boyd hopes to continue his which encourages health professionals secrets; diet and exercise are the main awareness campaign by walking the to lead by example. With that in mind, ways to deal with it.” entire length of the Bruce Highway over Dr Bill Boyd who is also the AMAQ vice- the course of the next four years. president, embarked on a 330 kilometre “And doctors, being role models, are walk from Cairns to Townsville. ideally placed to demonstrate to patients When Dr Boyd isn’t raising awareness who are overweight that it can be done.” about obesity, he is busy delivering his Dr Boyd said obesity is Australia’s much needed Outreach gynaecology number one health problem, and health For ten days Dr Boyd walked thirty service to Clermont, Moranbah, Dysart, professionals were just as prone to its kilometres per day to reach his final Middlemount and Sarina. effects as everyone else. destination.

“It’s all very well sitting around and talking about these things but in the end you’ve got to get up on your hind legs and actually do something.”

Dr Bill Boyd 28 Outreach Impact

Better beginnings on Palm Island

Palm Island is situated 70km north east of Townsville in the them to prescribe, refer to specialists and order tests such as Great Barrier Marine Park. It is a beautiful island with sandy pathology and medical imaging. In certain settings they can bays and rainforest covered mountains. Approximately have provider numbers and bill directly to Medicare. The 3,500 Aboriginal people call Palm Island home and it is one Outreach program supports Alex to provide maternity care to of Australia’s largest Aboriginal communities. The the women and families of Palm Island. are the traditional owners of Palm Island and the are the historical residents. Their ancestors were forcibly Alex, with the assistance of health worker Tuliana Dabea, relocated to Palm Island when it was used as a penal colony. provides comprehensive antenatal care, postnatal care and This caused a disconnection with traditional lands, culture and emergent midwifery care such as labour and birth. All the kin that has had long lasting implications. routine pathology, ordering of ultrasound scans and booking assessments are undertaken by Alex at the Joyce Palmer The poorest birth outcomes occur in Aboriginal mothers Health Service on Palm Island. Some women will require and babies reflecting the complex interplay between health specialist obstetric care and need to attend the high risk and socioeconomic disadvantage. While it would be naïve obstetric clinic at The Townsville Hospital but there is a great to suggest that maternity care could address all the factors deal of collaboration between Alex and the obstetricians to that contribute to the poor outcomes, there is no doubt that ensure as much of the care as possible can be done on Palm pregnancy is a unique time where women and families are Island. Women are encouraged to go to Townsville to birth motivated to provide the best for their baby and are receptive their baby. to positive change. As low birth weight and prematurity contributes to the risk of chronic renal, cardiovascular and The women and families of Palm Island have embraced the oral health disease in adult life, there are long-term benefits maternity service. The clinics are popular and more than to reducing the incidence of these factors. A primary health 95% of women receive five or more antenatal visits in their care approach that emphasises community participation and pregnancy. There is a very good ultrasound machine at control invests not only in the physical health of communities the clinic with 3D capabilities. Women enjoy being able to but also in their economic and social health. They promote ‘see’ their baby and while Alex acknowledges she is not a self determination and value community life which builds sonographer, she has attended ultrasound courses and can confidence and a sense of pride. take good pictures.

For the past 10 years Alex Gosden (pictured above), a Approximately 70% of women are seen in the first trimester midwifery nurse practitioner, has been providing midwifery of pregnancy which is better than the national average. Birth care on Palm Island. Nurse practitioners (NPs) are specialists weights have improved but there is still some way to go with in their area of expertise and have a scope of practice that reducing smoking rates. A recent addition to the team has challenges the boundaries of nursing. NPs were seen as a been a young parent’s support midwife who is planning to run way to help ease the pressure on doctors, particularly in areas programs to address smoking as well as providing postnatal where access to care can be difficult. They provide the highest support and parenting assistance. level of clinical nursing and their advanced practice allows Outreach Impact 29 Tackling diabetes together in Townsville The Townsville Aboriginal and Islander a new patient being referred to the Aboriginal and Torres Strait Islander Health Service (TAIHS) has more clinic. The clinic is based on a patient- culture and discussing family than 600 of their patients living with centred approach and supports self- traditions, particularly surrounding diabetes. The level of diabetes and/ management principles. food, and the cultural aspects of why or high sugar levels for Indigenous Jaymee-Leigh’s special interests are we eat what we eat. people is three times higher diabetes, chronic kidney disease and than for non-Indigenous people. maternal health and she provides Dr Theunis Kotzee, a senior medical TAIHS is committed to providing a advice about healthy eating; active officer at TAIHS, speaks highly about multidisciplinary approach to the living; testing blood glucose levels; the diabetes clinic. “Jaymee-Leigh management of diabetes for their understanding medications; and has been attending TAIHS as our Aboriginal and Torres Strait Islander caring for people’s heart, eyes, feet visiting dietitian/diabetic educator patients by providing a dietitian and and kidneys. since November 2014. Her services diabetes educator service. have greatly benefited our primary The diabetes service has enabled health care service as our patients In 2014, TAIHS was fortunate to find many TAIHS patients to lose weight; suffer from a large number of chronic someone who could provide both reduce or cease medication; decrease diseases including diabetes mellitus, services - Jaymee-Leigh Swift, who is their HbA1c into an optimal range, chronic renal failure, cardiovascular an accredited practising dietitian & a thereby reducing their risk of diabetes disease and others. Having a dietitian credentialed diabetes educator. related complications; improving their and diabetic educator on site has cholesterol levels and importantly greatly improved our health care Jaymee-Leigh’s clinic quickly became support self-management. team’s ability to assist these patients a very well utilised service which to improve their lifestyles, reduce soon required expansion due to the Jaymee-Leigh’s favourite part of their medication burdens as well as large number of people requiring the her job is developing a greater reduce hospitalisations.” service. Not a week passes without understanding and appreciation of

Kym Kennedy, Andreas Reiners and Jaymee-Leigh Smith 30 Outreach Impact

Far North Queensland

Healthy Habits for Healthy Woman The Royal Flying Doctor Service delivered services to women in with the help of some very well known sports people.

Kowanyama is a town on the side of The day consisted of breast self-awareness yarns, healthy in Far North Queensland and has a cooking activities, sit beFit classes and stretching, a population of 1,207. The Aboriginal people who live in this diabetes education talk, and Know your Numbers health community include Kokominjena, Kokoberra and Kunjen assessments. groups, among many others. Healthy skin and Pap smear yarns were held also, as well In their overarching Yir-Yoront language, Kowanyama as a meeting with elite sports people including Michael de means, “The place of many waters”. The community is Vere and Scott Prince (ARL/NRL), Kelly McKellar (basketball), situated on the banks of Magnificent Creek, a tributary and Beryl Friday (Firebirds netball), pictured below. of the Mitchell River, twenty kilometres inland from the coastline of the Gulf of Carpentaria. There was great participation with a great deal of interactive discussions, exercises and cooking session. The Royal Flying Doctor Service team provides health education and promotion to women in this community on a variety of subjects. Recently the RFDS team took the opportunity to visit Kowanyama when the Breast Screening van was due in town and to coincide with Stroke Awareness Week.

The team was made up of Kathleen Loadsman (chronic disease nurse) and Helen Hewett (child health nurse) from RFDS; Fiona Millard (health promotion) and Cathy Downey (diabetes educator) from Apunipima; and Maude Donas (senior health worker) from Kowanyama. Beryl Friday Outreach Impact 31 Much Needed Outreach Services in Ravenshoe Mamu Health Service is an Aboriginal Community Controlled Aboriginal or Torres Strait Islander. Health Organisation owned and managed by Aboriginal and Torres Strait Islander people to provide culturally appropriate Of these Aboriginal or Torres Strait Islander clients, 80% have primary health care programs for Aboriginal and Torres Strait a chronic disease, therefore the need to increase the GP Islander people and communities in Innisfail and surrounding capacity to develop enhanced primary care planning and team districts. care arrangements with the allied health team is crucial to the management of these patients. Mamu operates a part-time bulk-billing Primary Health Care Outreach Centre in Ravenshoe. With support from The GP is now able to visit Ravenshoe more than once a week CheckUP and QAIHC, Mamu Health Services has been able to and provides a bulk billing service which is accessed by 30 significantly increase the number of visiting health providers Aboriginal and Torres Strait Islander patients per week. to the Ravenshoe clinic. The staff from Mamu are already noticing many positive Currently, CheckUP and QAIHC provide funding support for outcomes resulting from the GP visit to Ravenshoe. the following health services into the Ravenshoe Primary Health Care Outreach Centre - general practitioner, respiratory “The continuity of care these services provide for the physician, registrar and nurse, podiatrist, dietitian, diabetes residents of Ravenshoe are resulting in significantly educator, counsellors and an optometrist. better health outcomes. The demand for this GP service is growing considerably. We have increased the service The GP service is a fundamental addition to the existing to two visits per week to meet the growing demand”. multidisciplinary team which services over 1,000 clients at the Ravenshoe Clinic of which 828 clients identify as being Highly successful multi-disciplinary paediatric outreach visit to Aurukun by Dr Alan Ruben In May 2016 the scheduled paediatric outreach visit by Dr Alan Ruben a consequence, we saw a total of 25 children referred for specialist to Aurukun was complimented by the inclusion of the Weipa based opinion, including 12 cardiology patients who were seen by Dr Reeves speech therapist Bernie Cantrell and, for the first time ever, the either solely or jointly if they also had non-cardiac health issues. paediatric cardiologist Dr Ben Reeves from Cairns Hospital. This visit not only saved the inevitable disruption for more than 20 Specialist paediatric outreach services to Cape York and the Torres families having to come to Cairns, but it also enabled the children to Straits are a collaborative initiative between the Torres and Cape HHS be seen in the familiar and more relaxed environment of their own and the Apunipima Cape York Health Council, with funding facilitated community. It was highly cost-effective, the $2,300 cost of the charter through CheckUP. The regular paediatric outreach provides face-to- was more than offset by a $60,000 saving to the Queensland Health face, telehealth consultations and an open telephone advisory service Patient Travel Support Scheme. to remote communities and rural towns in Far North Queensland. Aside from the benefits for the children and their families, it reinforced The 1,000km span of the service ranges from Yarrabah south of Cairns to all involved that living and working in Aurukun is quite different to Saibai Island, five kilometres off the Papua New Guinea coastline. from the usually negative portrayal of the community by the media The specialist outreach service visits most places at least every two and others. Dr Reeves, for whom this was a first visit, spoke for us all months. The core team consist of a paediatrician, an advanced when he described Aurukun as a pleasant and friendly community. paediatric trainee registrar and a general practice registrar. There are problems at times in Aurukun but these are similar to those seen on occasion in many areas of non-indigenous Australia where The paediatric outreach team works closely with child health social disadvantage exists. colleagues including child health and remote area nurses, Aboriginal health workers, allied health practitioners and general practitioners With our service delivery partners and CheckUP/QAIHC working closely employed by a number of organisations including Queensland Health, with local residents and staff we hope to expand this inter-agency Apunipima and the Royal Flying Doctor Service (pictured). Nevertheless multidisciplinary model to a number of the other large communities it remains necessary to regularly fly children down from the Cape through the course of the next twelve months. and Torres to Cairns and beyond to see sub-specialists or to have investigations, the most common requirement being for paediatric cardiology due to the high rates of rheumatic heart disease.

This visit was different; we usually visit the Weipa area over a three to four day period and conduct clinics at Weipa Hospital as well as at Aurukun, Napranum and Mapoon communities. We drive from Weipa to Aurukun on a day visit, a five to six hour return journey on often very difficult roads. On this occasion, by pooling our resources, it was economical to charter a small aircraft for the 25 minute flight which gave us significantly more time on the ground with patients.

A successful visit is not simply a matter of arriving in the community and seeing patients, it requires considerable coordination with the local community and health staff; it was months in the planning. As 32 Outreach Impact Provider Profile An interview with Louise Craig

Apunipima GP, Dr Louise Craig (pictured), has been visiting the small remote Cape York town of Laura every month for the past five years.

With funding support from Outreach Services, Louise recently increased the length of her clinics from one to three days per trip and has been provided with administration support for her visits. You have a spare week to do anything you want. Her first visit to Laura after this increase followed an What would you do? unexpected death in the town. Because Louise is very well Pack up the camping gear, boat and family and head out to the known in the community, the families affected were very reef. And turn my phone off! grateful for her extended presence at a sad time. The visiting mental health service commented on how valuable and helpful it was having Louise’s increased availability during this period. What sort of work do you most enjoy in general practice? Louise’s extended visits to Laura means she is now able to Chronic disease management is particularly satisfying as it spend more time undertaking comprehensive health checks means spending time with patients working through complex with patients and she arranges important follow-up reviews needs and promoting wellness. with the Indigenous health workers and allied health team. What is your key primary health care message to the We caught up with Louise to find out what life is like for a GP communities? visiting Cape York communities. Preventative health matters. It is important to see the health team regularly, and to get check-ups from the health workers. What is your background? Clinics are not just a place where you go when you are sick. I came to North Queensland as a back-packing doctor from England in 1992 with the intention of going home after 12 Can you share a message with other health months. I started work in anaesthetics at Cairns Base Hospital, professionals? was seconded to Thursday Island for six weeks and ended up Everyone should try outreach. It would be great if it was a staying two and a half years in the Torres Strait. Since then I mandatory part of training for hospital doctors to give them a have worked in Cairns or Cape York with Queensland Health better idea of the resources that are available remotely. and the Royal Flying Doctor Service. I’ve been a GP with Apunipima since 2010. Can you share a story of a patient/team/community who inspired you? What attracted you to Outreach? After 18 months of visiting the Mossman Gorge clinic, it was I enjoy working in complex health environments and a privilege to be invited to a Women’s Camp. About 30 of us particularly with Aboriginal & Torres Strait Islander peoples. spent time fishing, cooking, camping and sharing life stories. Everyone should have equitable access to healthcare. The time together in surrounds outside the clinic gave me a unique understanding of the womens’ lives and a different Which locations do you visit? perspective of the patient/doctor relationship. I am based in Cairns and I drive every second week for about four hours to either Wujal Wujal or Laura clinic. It’s a scenic What is your ideal solution/resolution to ‘Closing the trip along the Bloomfield track, with plenty of wildlife, river Gap’? crossings and the occasional fallen tree, which beats gridlock Educating children about healthy lifestyles and an increased in the city any day. I also drive to Mossman Gorge clinic (one focus on the social determinants of health. hour north of Cairns) in the alternate weeks. No two days are ever, ever the same. A quote from you encapsulating your feelings on Who did you last listen to when you drove? ‘Closing the Gap’? Anything from the Stones, Bowie, Elvis through to EDM. This Keep it in the spotlight. morning I was in a Paul Kelly kind of mood.

Outreach Impact 33

Healthy Hearing for Life Kris Tregenza (pictured), audiologist for Apunipima Cape York Through her visits Kris feels the impact her service provides Health Council, has been working to improve hearing health in is invaluable to the community. She says, “My key message Far North Queensland for over a decade. is that if you can’t hear, you can’t learn. That means learning words, learning language, learning the stories and history from Kris says, “Outreach audiology appealed to me from very the Elders, learning in school, and learning how to work as early on in my career. My personality and interests made an adult. We need healthy hearing for life. And the best way me an excellent candidate for Outreach work. My mother’s to have healthy ears is to have a healthy body – that means strong sense of social justice created a deep compassion for breastfeeding babies, reducing smoking and passive smoking, socially and economically disadvantaged peoples. An interest washing hands and faces, eating lots of fruits and vegetables, in sociology and anthropology means cross-cultural work and having a good sleep every night.” is constantly fascinating in all its challenges. Growing up with a father in aviation made small planes delightful rather than terrifying. Added to this, an enduring love of the harsh Australian landscape made dedicated Outreach work to Cape York my ideal job.”

She visits 11 communities across Cape York trying to visit the larger communities every six to eight weeks and the smaller communities about every 12 weeks. Kris collaborates with a range of other health professionals such as the Indigenous health workers, child health nurses, paediatricians as well as community based staff. This collaboration really is the key to the success of the Outreach program. The community-based leaders have taught Kris the history of each community as well as vital language words to help communicate with bilingual children. They also help Kris to engage with local families and keep her informed about the current context and social landscape of their people. 34 Outreach Impact

In this edition of Outreach Impact we have presented stories from the following locations in Queensland.

In total, Outreach services are delivered in 156 locations throughout Queensland. Outreach Impact 35 Thank you! CheckUP and QAIHC would like to thank all of the dedicated health providers and services for their commitment to providing health care where it’s needed most.

A.J.S Medical Services Fitzpatrick Family Optometrists Porter Eye Care Addiction Sciences Queensland Fleury, Dr Aisling Porter, Dr Timothy Akosile, Dr Oluwaseun FNQDocs Queensland Sleep Disorder Unit Alexandra Donoghue Clinical Consulting Franz Felfer Optometrist QUT Health Clinics - Optometry Amanda Gale Physiotherapy and Gidgee Healing Rachel Stone Podiatry Wellbeing Glasson, Dr William Rajendra, Dr Awal Apunipima Cape York Health Council Grice, Ms Lisa Relationship Connections Aboriginal Corporation Hadgraft Speech Pathology Riga Medical Enterprise Aranha, Dr Algenes Heart of Australia Ritchie and Associates - Psychologists Baralaba Private Clinic Hodgson Optical RM Miller Medical Barrett, Dr Claire I G Brown Medical Rodwell, Dr Steven Bernard Chin Medical Institute for Urban Indigenous Health Rothsay, Ms Deborah Bird, Dr Russell Integrated Therapy Solutions Royal Flying Doctor Service of Australia Bowler, Dr Simon Goondiwindi Rural and Remote Psychology Service Brian Todd Medical ISIS Psychology Services Rural Health Management Services Brisbane Eye Clinic IWC Rural Ultrasound Services Broadhurst, Dr Matthew Journeaux, Dr Simon Ryan, Dr Leo Cairns and Hinterland Hospital and Julian Boulnois Medical Sainani, Dr Anjali Health Service Kannangara, Dr Manjula Samahl Investments Cape York Guardian Pharmacy Kelly, Dr Wayne Sangla, Dr Kunwarjit Casey, Dr Terrence Klestov, Dr Elena Shaker, Dr David Central Queensland Hospital and Kumar, Dr Sandeep Sheehan, Mr Barry Health Service Leonidou, Dr Nadia Singh, Mr Adrian Central Queensland Regional Aboriginal Lifestyle Therapies and Training Sinha, Dr Ashim and Islander Community Controlled Solutions Skeletal Support Systems Organisation Likely, Dr Michael Skiathitis, Dr Irene Central West Hospital and Health Loumare Consultancy Smallcombe, Dr Katherine Service Mackay Hospital and Health Service South Burnett Physiotherapy Services Charleville Western Areas Aboriginal Malouf Medical South West Hospital and Health Service and Torres Strait Islander Community Mamu Health Service Stalewski Medical Health McGlade, Dr Andrea Stark, Dr Denis Children’s Health Queensland Hospital Metro North Hospital and Health Steel, Dr Jan and Health Service Service Suncoast Podiatry Churchill, Mr Rowan Metro South Hospital and Health Sweet as Diabetes Solutions Clarity Hearing Solutions Service Syed, Dr Farhan Collins, Dr Brett Michael Young Optometrists Tablelands Speech Pathology Compleat Nutrition Moreton Eye Group Taylor, Mr Kent Conway, Mr Graeme Mosby, Mr Edward The Optical Superstore Darwin Cooke, Dr Robert Mulungu Aboriginal Corporation Theodore Medical Centre Cooloola Physiotherapy and Allied Primary Health Care Service There4U Health Services Naidoo, Dr Navin Torres and Cape Hospital and Health Cooper Smith Optometrists Norrie, Dr Mark Service Cox, Dr John North West Hospital and Health Service Townsville Aboriginal and Islanders CQ Physio Group North West Remote Health Health Services Danesi, Dr Christopher Northern Australia Primary Health Townsville Hospital and Health Service Darben Medical Limited Tran, Dr Tommy Hospital and Health NQ Eye Specialists van der Westhuyzen, Dr Jasper Service NQ Family Practice Vital Health Diabetes and Health Solutions O’Brien Health Care Whittaker, Dr Amy Diabetes Care New Beginnings Optical Lenses Wide Bay Hospital and Health Service Diabetes Education Outreach Service Ossulton Services William Boyd Medical Dover, Dr Thomas Oxley Clinic William Talbot Eye Care DPB O’Brien Medical Palm Island Community Company Wowan/Dululu Community Volunteer Dugdale, Dr Alan Panizza, Dr Fiona Group Dyer, Dr John Parnell, Ms Jaime Wuchopperen Health Service Edwards, Mr Gareth Pavey, Dr Susan YM and J Tan Medical ENT Specialists Peters, Mr Lex Zeeman, Dr Sandra Evolution Podiatry Pioneer Podiatry Eyedentity Optical Poggioli, Ms Crystel 36 Outreach Impact

QAIHC CheckUP Level 2/55 Russell Street Level 2/55 Russell Street SOUTH BRISBANE Q 4101 SOUTH BRISBANE Q 4101 07 3328 8500 1800 339 237 [email protected] [email protected]

The Outreach programs are made possible through funding from the Australian Department of Health