Reflecting on Our Medical History

♦ Reflecting on our medical history

North Coast Health Matters Autumn 2019 in this issue

Editorial 3 Local GP Tenders Close 4 Federal Election 2019 - Labor’s health initiatives 5 Sawbones, Saddle Sores & Soothing Balms - eBook Review 6 Changes in the wind for PHNs? 8 Doctors consider the environment 9 Rotary Park is Lismore’s rainforest heart 11 ‘Dog’s life’ takes on new meaning 12 Front cover: Images provided by Dr Neil Northern Rivers doctors win NSW rural medical awards 13 Thompson from his book : Sawbones, Team work the key to better emergency care 15 Saddle Sores and Soothing Balms. Reflections of the retiring NCPHN Chair 16 Top left: William H Tomlins, Alstonville The Hannah Cabinet is two-thirds Lismore’s 19 Top right: Margaret A Corlis in her surgery Homelessness is a hidden blight that needs healing 20 at Bangalow Book Review - the Social Leap 21 Lower left (photo NSW State Archives): Youthful understanding of local Country 22 Jessie Marie Stewart started a practice in Bundjalung upgrade for Goonellabah hub 23 rooms in Molesworth Street, Lismore, at ‘Scale-C’ is a new pinnacle of hepatitis C treatment 25 the end of January 1907. Getting food facts back on the table 27 Lower middle: Nicholas Kerkenezov, Book Review - Eggshell Skull 29 Resident Medical Officer at Dubbo Base OAM honour for local anaesthetist 31 Hospital in 1943–1944, started in general practice in Woodburn. Dosage a key factor in medication adherence 31 Lower right: Josiah Corlis on the verandah of their Bangalow home in Granuaille gpspeak on the web: www.gpspeak.org.au Road, was involved in community affairs search - GPSpeak is available in pdf and Issuu format from our website. Article refer- and responsible for setting up the private ences are available via the online hot links. hospital in Bangalow. In 1952 it was subscribe - Get the latest from GPSpeak by subscribing to the newsletter that comes renamed the Bangalow District War out once or twice each month. Add your email address to the form in the right sidebar. Memorial Hospital. write - Unless otherwise stated all articles in GPSpeak can be reshared under the Creative Commons Attribution-ShareAlike 3.0 Australia license. GPSpeak welcomes contributions from members and the general public. tweet - Follow @gpspeak and comment on #gpspeak.

editorial team

Dr David Guest Clinical Editor [email protected] Dr Andrew Binns GP Contributor [email protected] Robin Osborne Editor [email protected]

Angela Bettess Design [email protected] www.whiteduckdesign.com.au

2 | GPSpeak Editorial

The grand era of local medical care continues

The first white settlers came to the North All members of the team are crucial to Coast in the 1840s, a time when few of achieving this aim and everyone from the the things we take for granted today even most experienced surgeon to the youngest existed. Medical treatment, such as it was, wardsman has their part to play. Most hos- came in the 1860s and 1870s with the pital patients, however brief their stay, will arrival of the first doctors. marvel at how efficiently things run when everybody is focussed on their job and how In this issue we review (page 6) Dr Neil smoothly it all works when the team is per- Thompson’s history of the Richmond have been successful due to the combina- forming well. Valley doctors from 1866 to 1986. Many tion of science and modern medicine, to- people, both medical and lay, are fascinat- However, they also observe that things do gether with competition, consumerism and ed by this history and have wanted to learn not always go well and can even can go very the work ethic that in turn depend on the more about their predecessors. badly. inviolability of property rights. To help get these stories to a wider audi- On page 15, Dr Charlotte Hall describes The extent to which efficiencies can be ence the NRGPN and the Nordocs Group the improvements that can be achieved derived from market forces in the deliv- have liaised with Dr Thompson to have the when attention is paid to getting the team to ery of primary care services is currently book published in electronic format as an focus on their “team work”. Along with her being tested by the Australian govern- Amazon Kindle ebook. We thank Neil for colleagues she has developed the ADEPT ment through its Primary Health Network allowing us this privilege and pay tribute to training course that teaches medical per- system. There are potential pitfalls with this him for the many hours of devotion to our sonnel the human-factor skills such as approach and the Australian Labor Party community that he spent in researching leadership, communication, assertion, con- has signalled that there may be changes and writing this history. flict management, self-awareness, situation should it win government in the election awareness, and decision-making that can expected for May. We also pay tribute to three GPs recent- literally make the difference between life ly honoured by the Rural Doctors Network In his final Reith lecture,Civil and Uncivil and death in emergency situations. (page 13). Ian Falson and Chris Mackenzie Society, Professor Ferguson notes that not of Ballina and Anil Thakur of Maclean were According to Neil Thompson innova- all services are best delivered by govern- granted the organisation’s Rural Service tions in medical care such as this have a ment. He sees a role for both public and Medical award in recognition of the special long-standing tradition on the North Coast. private organisations in education at both skills they brought to their communities On page 29 Dr Zewlan Moor reviews the the secondary and tertiary levels. While he and the years of service they have provided. book Eggshell Skull that deals with the does not address the issue per se it would be medical, social and legal costs of sexual reasonable to make the same argument for Dr Chris Lowry (page 31) has been assault. Dr Moor has pioneered bibi- medical care at the primary and secondary awarded the Order of Australia Medal for lotherapy for patients on the North Coast. levels. services to anaesthesia in the Australian However, this book is recommended as Honours list. The award is richly deserved However, Professor Ferguson is a strong therapy for the medical professionals treat- for his years in hospital administration, supporter of local community groups that ing these patients who may suffer the vicar- medical training, overseas volunteering come together to address a local need or ious injury that this work may invoke. and for his expertise in underwater medi- issue. In his own case he has high praise for cine. Hep C is now a curable condition and the his local Lions Club in the south of Wales. Australian government is to be congratulat- We also mark the end of an era with Nordocs is the local group of doctors on ed for making the medication affordable for the recent retirement from the North the Far North Coast of New South Wales. It all Australians. However, affordability does Coast Primary Health Network of Dr Tony has its own Facebook page, meets for drinks not mean accessibility. Through their work Lembke. On page 16 Dr Lembke reflects on once a month in a local watering hole and is with Balund-a residents, which is a diver- his time leading the local primary health holding its annual “Unconference” in June sionary NSW Corrective Services facility care organisations, first established in the this year. All local medical practitioners south of Tabulam, Drs Binns and Silber- early 1990s as Divisions of General Practice are invited to come along, have a chat with berg have identified a significant incidence and later morphing into General Practice their colleagues, listen to the talks or better of potentially curable hepatitis C infected Networks, Medicare Locals and now the still give one. patients that can miss being treated in the present day Primary Health Networks. jails (page 25). They have teamed up with Tony’s work has been a shining example Professor Greg Dore of the Scale-C project of the Institute for Healthcare Improve- that uses innovative techniques to address ment’s fundamental tenets. He has aimed the issues in this vulnerable group. to improve the efficacy of the health care The 2012 Reith Lectures The Rule of Law system in addition to improving the health and Its Enemies was given by historian and of his own patients while at the same time commentator Professor Niall Ferguson. In valuing the skills and input of all those in- this series he argues that modern societies volved in health care delivery.

GPSpeak | 3 Some, however, have expressed concern that they are taking on significant risk if Local GP Tenders Close they are relying on payments that are dependent on the actions of others. Strong fi- Love me, tender, love me true, all nascent clinical societies in the Richmond nancial incentives will be needed to justify my dreams fulfilled. Valley, first started by the NCPHN when the risk, and many practices have chosen funded under its prior arrangements. not to apply. For my darlin’ I love you, and I always will. As is standard practice the tender doc- Some practices have expressed concern uments have been removed from the that these bonus payments will be viewed Love Me Tender, Cinemascope NCPHN’s tendering portal and no further as a money-making venture for the doctors Films, 1956 information is available while the NCPHN and not focussed on achieving the best for Two of the North Coast Primary Health works its way through its commissioning the patient. There could be a temptation Network’s tenders for the delivery of ser- cycle. to skimp on service delivery to maximise vices to North Coast GPs and their patients profit. The NCPHN’s Exercise as Medicine closed in January-February. tender has also closed recently. The aim There is also the potential to game the The first contract is for an organisation, of the project was to choose a cohort of system by “pulsing” the health of the or organisations, to provide education- chronic disease patients from a select patient to achieve the bonus payments on al services to primary care practitioners group of North Coast practices to engage in every second round of the six-month cycle from the Tweed to Port Macquarie. These a regular exercise program. of the project. services are directed at medical practi- The project is novel in that the practices Exercise as medicine is a long-term un- tioners, nurses, allied health practitioners will be paid a success fee for those patients dertaking if the benefits from this import- and pharmacy, and focus on the NCPHN’s who improve on performance measures ant intervention are to be achieved. The target areas for the next triennium. over a six-month period. This payment is Exercise as Medicine project goes for three The contract is thought to be best suited available every six months if the patient im- years and its continuation beyond that will to large educational organisations that have proves from their previous baseline and is depend on its success. Clearly, however, a the capacity to cover both the wide footprint in addition to the usual start up and service sustainable approach is required. of the NCPHN and to deliver quality pro- delivery funds of the project. Many GPs are confused by these changes grams for health professionals with diverse Health funders have long preferred to patient care and the strange new world interests and responsibilities. paying for outcomes rather than activi- of the tender. At this early stage few are Local medical practitioners are hoping ty and this project will be watched closely keen to swipe right. from around the country. that the funding will allow the return of the by Dr David Guest

We believe care should be focused on the patient, the individual. That care should be available when and where the patient needs it most. And it should be designed to help give patients the best possible life outcomes.

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GPS Advert V1.indd 1 13/08/2018 2:25:50 PM 4 | GPSpeak Federal Election 2019 - Labor’s health initiatives by Dr David Guest

services. This cost shifting has in turn been Labor is a better steward of the Australian Ahead of the federal election predicted countered by the States through increasing health system. She notes that at every elec- for May 2019 the Shadow Health Minister the number of hospital specialist outpatient tion the Liberals break their promises on Catherine King has announced Labor’s new clinics and services that require referral health. policies on her portfolio area. This comes in from a general practitioner. The cost of the wake of Labor’s “Medi-scare” campaign Tony Abbott’s 2013 “No cuts to health” these bulk billed services goes back to the in the previous election, still drawing criti- was immediately followed by $2.8 billion Commonwealth. cism, and now, comparison with the Coali- cuts to hospital funding over a 10 year tion’s scare campaign on boat borne asylum The Federal government’s glacially slow period; an attempt to introduce co-pay- seekers. thaw of the Medicare freeze (as previously ments on doctors’ visits; the Medicare ) started almost two freeze, which resulted in a virtual co-pay- Speaking at the National Press Club Ms reported in GPSpeak years ago. Under the Coalition’s arrange- ment system; mooted but an ultimately King outlined her party’s vision for Medi- ments some items continue to be frozen withdrawn proposal to outsource Medicare care funding and the future of Australian and will not return to increased funding processing; cuts to the PBS and Medicare general practice. until 2020. Under Labor the freeze would safety nets; and cuts to preventative dental It has long been recognised that many end immediately. programs and diagnostics. of the difficulties in the Australian health Over the last six years $3.0 billion have She continues that in more recent times system arise from the split in responsibil- been shaved from Medicare rebates by the Health Ministers Dutton and Hunt de- ities between the primary and secondary freeze. Since the money is a rebate to the stroyed the Medicare Local system and health sectors, which are under the control Australian public for fees incurred, it is im- could have ended the Medicare freeze at of the Federal and State governments re- practical for the money to be returned to any time in the last five years. spectively. Far too much time and money them. Australian GPs will look askance at is wasted in driving patients, hence costs, Health policy has been a major strength this reasoning. from one sector to the other and back again. for Labor going back to the days of Medi- The Shadow Minister notes that the bank under the Whitlam government. They Australian politics in recent times has current Health Care Homes (HCH) trial campaign strongly on the issue, while the seen a succession of changes in leader- has essentially been a failure. However, the Coalition’s record is weak and Health Min- ship and changes in government, the latter lessons learnt from the trial are invaluable ister Hunt has been fairly passive in his on a two-term, six year cycle. The current and should lay the foundations for a better portfolio. polling suggests this cycle will continue and wider implementation of the HCH with the next Federal election. The Shadow Minister claims that under principles. Labor there will be better hospital funding, Each new government comes to power Primary health care reform is a difficult stable health insurance premiums, afford- with a mandate for its policies, often issue and will take time and careful negotia- able GPs and specialist visits, and that opposed to those of the previous govern- tion. Labor sees primary care delivery such Medicare will remain the core of the Aus- ment. However, changes in health, like as that provided by Aboriginal Medical tralian healthcare system and its long term many other areas of government responsi- Services as a model for future general prac- development will progress more smooth- bility, can take decades to plan, implement tice. She wants more emphasis on health ly under the new national Health Reform and refine. care promotion rather than treatment and Commission. To overcome this destructive cycle, Labor laments the $300 million cut from the Australian GPs may not see it as all is proposing a national Health Reform Coalition’s National Preventative Health puppies and rainbows. They will recall Commission (HRC). Inspired by the Pro- Agreements with the States in 2013. that it was Labor who first introduced the ductivity Commission an HRC would be It is calculated that 1.3 million pa- Medicare freeze in 2013. They will recall the an independent authority charged with tients delay or skip medications, tests and market disruption caused by Labor’s Super improving systems and outcomes and re- medical appointments due to costs. As an Clinics following the 2007 election. Labor ducing inequality in health. It will report immediate response to hefty specialists’ out sees health centres such as those run by the jointly to the Federal and State Health Min- of pocket costs, Labor is looking to expand AMSs as the future for Australian general isters through the Council of Australian the role of hospital OPD departments. It practice delivery and this is also the ap- Governments. COAG ministers will be able is not clear from the announcement how proach favoured by the . to direct the Commission to certain areas NSW Greens these extra services will be apportioned and for development and this, combined with The details of the proposed restructur- funded. the joint reporting, is hoped to make it less ing of primary care are scarce. Consensus likely for the Commission’s reports to be The Shadow Minister is also critical of the building by bringing together State and buried by the government of the day. disbandment of the Medicare Locals under Federal governments, doctors, pharmacy, the Abbott government’s then-Health Min- health insurers, the hospital sector and The second plank of the Labor initiative ister, Peter Dutton. In her view, the destruc- consumer representatives sounds fine in is primary care reform. Shadow Minister tion of the previously established networks principle. However, such a “consensus” King reports that the Treasury estimates has put primary health care development may see one group objecting strongly to a given to the Coalition government prior back several years. However, no announce- reduction in their incomes. to the 2013 first Coalition “horror budget” ment about the Labor Party’s intentions for correctly identified that the increase in out Medical practitioners are advised to Primary Health Networks was made. of pocket costs would drive patients to use proceed with caution, or as the Romans more hospital Accident and Emergency The Shadow Minister concludes that advised, festina lente (make haste slowly).

GPSpeak | 5 Sawbones, Saddle Sores & Soothing Balms - eBook Review

“History is more or less bunk”, according to Henry Ford. Back in the 1850s so was medicine on the North Coast. Dr Neil Thomp- son’s history of the the local medical fraternity, Sawbones, Saddle Sores & Soothing Balms covers the 120 years from the arrival of medical practitioners in 1866 to the modern era. Neil Thompson’s fascinating book, first published four years ago, has recently been released as an Amazon kindle ebook, a format that will enable the stories of the medical pioneers of the region to reach a much wider audience. Each chapter is devoted to one of the sixteen towns in the local area, detailing the travails and contributions of each town’s medical practitioners in chronological order. Various themes emerge. Life for the early medicos, like their patients, was difficult, The temporary isolation ward at Lismore Hospital,used during the typhoid epidemic in 1892 lonely and often short. In the two major townships of the day, Coraki and Casino, es. Thompson quotes the obituary of one, towns developed, swimming, fishing and there might be a colleague one could call on who succumbed to “that cordial that de- horse riding gradually gave way to tennis, in times of need. Mostly, however, the local stroys both soul and body of men”. Suicide golf, hockey, running, sailing and surfing. doc was on his own delivering babies, treat- claimed others. Even to this day many local practitioners will try to attend a “Board Meeting” at least ing surgical conditions and coping with Prior to antibiotics vaccinations were once a week. major trauma. one of the few things that could be done to In those early days there were no hospi- reduce the death toll. Smallpox and varicel- The early medical practitioners were tals, not much in the way of anaesthetics and sterilization was a novel concept. A good surgeon was quick and had a strong arm, an attribute he shared with his anaes- thetic assistant. Appendicitis and peritoni- tis could prove as fatal for the doctor as his patients. Perinatal mortality was 20%. Snakebite, drowning and being thrown from a horse could easily strain the practitioner’s therapeutic armamentarium. Infections were common, with epidemics of measles, smallpox, Spanish flu, bubonic plague and typhoid sweeping through the community at various times. Death from tuberculosis or pneumonia in your 30s was not a rare event, even for the medical staff and their families. Getting started in practice was as challenging then as it is now, although the prob- Lismore Clinic during the 1954 floods lems were somewhat different. There were no regulators to satisfy and getting a Medi- care prescriber number was a thing of the la lymph inoculation clinics were run with often prominent in their town’s local distant future. Rather it was often simply a serum shipped up (literally) from Sydney. musical groups and gardening societies. matter of hanging up your shingle. Life was simpler when hepatitis B and con- This tradition too has continued across scientious objectors had yet to be invented. the generations with local doctors Jimmy Some established their rooms in the local Chiu playing regularly in the band Acid hotel. While this attracted early custom The early records noted that many Bleed and the late Tex Miller famous for it could have unintended consequenc- doctors of the day enjoyed their sports. As his “banjo plucking” at the Lismore Golf

6 | GPSpeak Club with his “Pally’s Players”. Psychiatrist Harry Freeman, who came to the area for the Aquarius festival, still entertains with a hot jazz piano. The local doctor, an eminent citizen of the town, would be expected to attend the town’s balls and dances. He would be an honoured guest at the annual show. Occa- sionally he might be called upon to perform the professionally dangerous job of judging the baby competition. The doctors of the day were early adopt- ers. Horseless carriages were an innovation in transport and often doubled as the early ambulances. However, the thrill of speed went to their heads on occasions. In Ballina in the early 1900s Dr John Sanderson was fined by the Inspector of Public Nuisances for “driving his car around a corner of the road at faster than walking speed”. In 1908 in Lismore Dr Oscar Muller, driving his dark-red Russell, “was charged with driving Mullumbimby’s Dr Kesteven in his horse and buggy (right) and light pony and trap in the at the breakneck speed of more than six background, c.1905 mph and fined ten shillings and costs”. They were accompanied by their two good repute. Francis Hankey, “a medical medical sons, Philip and Charles Corlis who man of Wardell”, was a serial fraudster and Dr De Luca was one of the pioneer flying established their practice in Ballina. The over the years was found out repeatedly. He doctors. He spent several months “build- family tradition was carried on by Charles’ appeared before the magistrate in Wardell, ing a monoplane which he ‘essayed to fly’. son Wilson Corlis who was a surgeon in Casino, Lismore and Grafton. Most of his After taking to the air in graceful fashion, at Lismore from the mid 1930s until the end medical training probably occurred during about twenty feet it suddenly turned turtle, of the war. his time in Darlinghurst, Maitland and Port fell and was completely wrecked”. He sur- Macquarie jails. However, “‘Dr’ Hankey’s vived the crash which tragically was not the Other father and son doctors in the treatment for painful conditions” was a case for a later Casino medical aviator. area were Frederick William Buddee who marketing success and almost irresistible started practice in Bonalbo in 1927 and Many of the medical fraternity respond- to his long suffering patients. his son, also F. W. Buddee, a respected ed to the call to public service. Four of Lismore surgeon and community member. Lismore hospital opened in 1883 when them were mayors of their local towns. In Similarly Archelaus Opie and son Jim pro- the town’s population was 473. The town the early 1930s Dr Jabour of Casino and vided medical services to the North Coast had been gazetted only seven years earlier Dr Kellas of Lismore were simultaneously for over 50 years and Robert Oakeshott, in 1876 having previously been known as mayors of their respective communities. the son of John, worked as a surgeon at the “Sleepy Hollow”. In those early days the A weir is named after the former, a street Keen Street Clinic for several years before relationships amongst the local doctors after the latter. moving to Perth. and between the doctors and the hospital Many of the doctors served overseas boards were not always harmonious. Argu- Present NRGPN Chairman Nathan Kes- during the World Wars, taking leave from ments with medical “squatters” and rogues, teven, traces his medical roots back to their practices for several years. Tragically charlatans and con men would episodical- Leighton Kesteven his great great grand- Dr John Oakeshott was captured in the fall ly cause havoc. It would have been almost father in the early 1900s. English born and of Singapore and died several years later in enough to make them want for modern trained at St Bartholomew’s he worked in Borneo on the Sandakan Death March. institutions like provider numbers and the Fiji and Lismore before becoming the first AHPRA. Upon retirement Malcolm Tester, a medical practitioner in Mullumbimby. Lismore ophthalmologist, following the There are dozens of other colourful Over the years many doctors came to the example of world renowned Dr Fred doctors who have served the people of the North Coast, attracted by the scenery and Hollows, undertook several eye missions Richmond Valley over the last 120 years. the lifestyle, and decided to stay. Instru- to India and the Solomon Islands. Lismore Neil Thompson’s book gives us a glimpse mental to attracting new doctors in the surgeon Dr Dave Thomas was a medical into our distant history and offers some 1970s and 1980s was Lismore Base Hos- officer to the Surf Life Saving Movement. guides on how best to serve our community pital Clinical Superintendent Ray Gordon. He ran voluntary skin clinics at Byron Bay in the future. Thompson reports that one of the more fre- beach every December-January holidays quent answers to the question of why new until he tragically lost his own life to mel- The book is available from Amazon as doctors came to Lismore was that they had for mobile phone and tablets. anoma in 2000. a Kindle app met Ray Gordon somewhere or other and The many pictures in the book prevent it For some early practitioners doctoring he told them of the attractions of his home from displaying on the web or the native was a family tradition. Canadian doctors town. Kindle device. Josiah and Margaret Corliss were the first It is true that not all the medical prac- It retails in Australia for $11.99. medical practitioners in Bangalow and pro- titioners of the North Coast have been of vided medical care throughout the region. GPSpeak | 7 Changes in the wind for PHNs?

Should Labor win this year’s federal elec- proach to health, the abolition of Medicare tion it seems likely that the Primary Health Locals and re-establishment of Primary Network (PHN) system will be retained but Health Networks (PHNs) was unnecessary face a number of changes. This is the signal and counter-productive. coming from the long-serving Shadow Min- Labor is particularly concerned by the ister for Health, ALP parliamentarian Cath- narrower focus and less flexible funding erine King who responded to an inquiry that the Abbott-Turnbull-Morrison Gov- about the PHNs from GP Speak. ernment has imposed on PHNs. Established on 1 July 2015, after the dis- However, Labor continues to strong- banding of the Medicare Locals, there are ly support PHNs. We believe that they 31 PHNs in Australia, the local one being are uniquely placed to identify and help the North Coast Primary Health Network address local health needs – both within https://ncphn.org.au extending from and beyond the current Government’s Tweed Heads down to Port Macquarie. funding priorities. In fact, Labor is already Despite describing the move to establish working with many PHNs to identify local the PHNs as “unnecessary and counter-pro- priorities ahead of the next federal election, ductive”, Ms King said Labor “continues to due by May. strongly support” them. But PHNs can only do their important Her statement is as follows - Catherine King, MP work in partnership with GPs, other providers and patients, and they must continue “The last Labor Government established health care reform around Australia. to build local collaborations and trust.” Medicare Locals to help drive primary Typical of the current Government’s ap-

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8 | GPSpeak Doctors consider the environment

by Fiona McCormick, Doctors for the Environment, Australia

GPs are used to dealing with the politics they place increased pressure on emergen- between CO2 levels and temperature. of health, from the cost shifting which cy services, increase air pollutants, inter- Australia is a technologically advanced sees patients discharged with scripts they rupt electricity supplies and transport ser- nation and we have bountiful supplies of cannot afford to fill through to the regula- vices, increase the incidence of workplace sun, wind and other renewables to easily tions around ordering MRIs (to name but accidents and injuries, and contribute to achieve zero emissions in power genera- two). Clearly, political decisions impact our drought and its profound impact on mental tion. Individuals and companies are invest- delivery of primary health care. So it should health. ing in these technologies as a way to reduce not be surprising that health power bills and ensure unin- practitioners may wish to terrupted supply, however to influence policies on a scale date there has been a lack of broader than just dealing meaningful investment at a with health care delivery, Federal or State level. widening our perspective to look at the social and envi- As we subsidise the fossil ronmental determinants of fuel industry to a tune of health. around $12bn p.a, it is evident that what has been Doctors for the Environ- lacking is political will, ment Australia (DEA) arose which Nobel laureate Al as a branch of the Interna- Gore defined as one of the tional Society of Doctors for “ultimately renewable re- the Environment (ISDE), sources”. founded in 1990 and now having member organisa- I am a GP. For over a tions in over 30 countries. decade I worked as a locum in rural and remote Indig- The aims of ISDE are to enous communities, where publicise the relationship the resilience and long view between the condition of of the original inhabitants the environment and human health, to Hot weather can also mean increased of this country never failed to impress me. promote environmentally friendly be- bushfire risk with more extreme fire As one elder said to me: “Healthy people haviour amongst physicians, patients, and weather and longer bushfire seasons. Bush- caring for healthy country is what makes a the public, and to cooperate at all political fires have direct impacts on physical and healthy society”. levels in the reduction of harmful environmental health through burns, heat stress, mental influences on health. We know that people cannot be healthy trauma and death. Bushfire smoke can di- if the air they breathe, water they drink and DEA has been an active voice in Australia rectly trigger heart attack and lung com- food they eat (all from country) are pollut- since 2002 and the organisation regularly plaints, increase hospital admissions, and ed. Equally we know that actively caring for publishes its position papers on climate cause death. country keeps people healthy both physi- change and human health. Hotter than average conditions in Austra- cally and emotionally. With this year’s elec- The Bureau of Meteorology recently re- lia and the polar vortex which froze North tions in NSW and federally, it is timely to leased data showing that Australia’s mean America are due to climate change directly consider how our votes can influence pol- temperature for January 2019 exceeded caused by the increase in greenhouse gases icies that will affect the environment, the 30°C, the first time this has occurred for in the atmosphere from human activities, health of our nation and our planet into any month. National temperatures have in- mainly the burning of fossil fuels. CO2 is the future. Collectively we can do more and creased by more than 1 degree over the past approximately 410ppm, higher than it has I urge you to consider supporting the im- 100 years. Prolonged periods of heatwave been in over 400,000 years and we have portant work of DEA. conditions are particularly dangerous as all seen the graph showing the correlation

GPSpeak | 9

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Contact details: - Ph: (02) 6621 9105, (02) 6621 6758 Fax: (02) 6621 8896 WEB: - www.coastalvascular.com.au EMAIL: - [email protected]

CONSULTING LOCATIONS: Lismore – 79 Uralba Street Ballina – St Vincent’s Specialist Suites, 1/75 Tamar Street Casino – North Coast Radiology, 133-145 Centre Street Grafton – Specialist Suites, 146 Fitzroy Street Glen Innes – East Avenue Medical Centre, 39 East Avenue Armidale – 3/121-123 Allingham Street Inverell - St Elmo Medical Practice, 27 Oliver Street

Rotary Park is Lismore’s rainforest heart by Dr Kristin den Exter foxes need the trees and the trees need the flying foxes to reproduce. Rotary Park, a globally unique dry rainfor- I joined WIRES, Australia’s largest wild- est remnant, is culturally and spiritually life rescue and rehabilitation charity, in significant for the Widjabal Wiyabal people 2004 and before long our house was full of of the Bundjalung Nation. One of only two birds, possums and gliders. At home with urban rainforest remnants in NSW, the a toddler, working as a casual lecturer in park’s circular walking track was opened Environmental Science at Southern Cross in 1988 after substantial efforts by Lismore University, meant wildlife caring had room City Council and bush regenerators, led by in my life. My interest in flying foxes led me Rosemary Joseph, to rid the rainforest of to being vaccinated with the rabies vaccine invasive weeds. This work is ongoing. to allow me to work with these amazing creatures without any risk, however small, In September 2005 Lismore’s flying of contracting lyssavirus (it is estimated fox camp relocated from the riverbank at only 1% of the animal’s population carries Currie Park, near the Lismore Racecourse, the disease). to Rotary Park where the camp remains today, protected from extreme winds, and One warm day in 2008 I took a lunch at times extreme heat, by the parks unique break walk in Rotary Park. We were worried microclimate created by the gully, creek about the bats as that summer there was a and the tall trees. Scientific studies reveal blossom shortage. What I found that day that flying foxes’ preferred roosting habitat in the park was a horror story unfolding. In Lismore this summer the WIRES is where there are emergent trees, patches It was early December, and the tiny flying Rotary Park release aviary has around 30 of dense foliage and an understorey. fox pups had been abandoned by starving young bats, almost old enough and strong mothers who had flown too far to return to enough to be soft released to join the More broadly, flying foxes prefer much their young in search of food. nightly fly out. These babies have come in the same habitat as we do - the east coast as a result of becoming lost after falling off coastal lowlands. This has meant much of Everywhere I looked there were pups mum, being caught on barbed wire or in the tall coastal forest habitat that flying crying out for their mothers, clinging for fruit netting. There is one Little Red Flying foxes depend on for foraging and roosting their lives on shrubs, vines, and trees. fox who was separated from his migrating has been cleared for agriculture and human Over the next week 180 baby bats were colony and is slowly being transported back settlement. Flying foxes now depend on the rescued from Rotary Park, as well as through the wildlife care network to North pockets and remnants, like Queensland. Rotary Park. I am now lucky to live At times during summer next to Rotary Park, three species of flying foxes can working with others to be found in the park; the Grey restore and regenerate Headed Flying Fox (Ptero- the neighbouring forest pus poliocephalus), the Black at Claude Riley Reserve, Flying Fox (Pteropus alecto), just behind Lismore Base and occasionally for only few Hospital. Every action days in the year the migratory taken to prevent further Little Red Flying Fox (Ptero- habitat loss, or to increase pus scapulatus). Rotary Park the area and condition of is considered to be one of the the remnant forests that largest maternity camps for are left, will help these im- the Grey Headed Flying Fox, portant keystone species listed as threatened due to survive. declining numbers across the east coast population. If people find a sick, Lumley Park in Alstonville. The bat caring injured or entangled bat it is important Flying fox populations are linked as one network went into full swing, with bats not to approach it. If you see a bat on the across the species ranges, with flying foxes in care across the NSW east coast. That ground, adult or pup, please do not touch travelling up to hundreds of kilometres at summer the release aviary, where the it. Although less than one per cent carry night in search for food - the flowers and young bats learn to be bats and dehumanise lyssavirus, there is always a risk. If you blossoms of our tall native forests. from their carers, was extremely crowded. find an injured bat in the Northern Rivers Flying foxes are a keystone species, pol- Other similar mass mortality events have call WIRES 6628 1898. Elsewhere you can linators that can see from kilometres high occurred in Casino and SE Queensland call the WIRES Flying Fox only Emergency the blossoms of our tall coastal forest trees in 2014, the NSW in 2016, the Northern hotline 0405 724 635. which open to the night sky. The flying Rivers in January 2018.

GPSpeak | 11 ‘Dog’s life’ takes on new meaning

Companion dogs have been an important part of chronic pain sufferer Dawn Macintyre’s long journey to better health, as Robin Osborne reports.

Surrounded by her beloved “oodle” dogs – more of which later – Dawn Macintyre looked a picture of good health and happiness when I visited the Clunes property she shares with husband Neil. ‘Highland Retreat’ is idyllically located, with alpacas grazing in the top paddock near a large Hollywood-style sign spelling out the word LOVE. For many years, however, Dr Mac- intyre lived a very different life, suffering from intense chronic pain dating back to her early childhood in England when she had multiple surgeries for stomach and bowel conditions, spending, she estimates, around five years in hospital. Later, keen to be involved in sports, for which she had a natural aptitude, she took up horse riding only to be trampled by a horse at the age of 14, badly injuring her back and causing decades of pain. Failed back surgery syndrome (FBSS) was the therapy, a largely unexplored field and not families of children who have drowned. core diagnosis and the condition has never supported by the university. Her thesis offered the opportunity to ‘give fully left her. From 2013-17, having moved a voice’ to those families who all too often Nowadays, surrounded by her oodles, she to Australia, she would become a hospital struggled through their grief with limited well understands the role that animals can regular in Brisbane and then the Northern support and understanding from profes- play in the therapeutic process. Rivers, with the equivalent of a year as an sionals and the community. inpatient as well as extensive rehabilitation Instead of further study she went travel- Equity of access to health care and emo- visits. ling with a friend, following the overland tional support for people in need is a subject route to Australia via places almost im- Pain may not be the four-letter word close to her heart. She is currently writing a possible to visit nowadays, especially for a prominent in her landscape but it is never book on her journey with chronic pain and blonde woman – Iran, Afghanistan, Paki- far from her mind. She vividly recalls the the gaps that she identified through this stan… many neurological flare-ups that left her long and challenging time of her life. A body wracked with debilitating pain, strip- Eventually she settled in Perth and later previous work was titled “Nothing Changes ping 20kg off her relatively slight frame, Brisbane where she resumed her educa- if Nothing Changes: A Practical Guide for and leaving her unable to find lasting solu- tion, completing a Master of Public Health choosing the Right Counsellor”. tions. through Curtin University, and working as She is an Adjunct Professorial Fellow at Media Marketing Manager for Queensland “What was devastating, apart from the Southern Cross University. impact on my partner, family members, Transport and later Manager, Queensland notably grandkids, was that I couldn’t find Injury Surveillance Unit, Mater Hospital. Last year Dawn Macintyre completed a any answers… and I’m a professional re- At the same time she had a private clinical 12-week stint of planned rehab at Ballina searcher. If I can’t do it, how does the pro- counselling practice and was also a foster District Hospital (whose staff she greatly verbial Joe Blow even begin?” parent. admires) – “gentle exercises, mind-body connection, validation of pain, processes to Her passion was the wellbeing of young When it became clear that the young avoid catastrophizing - all these things have people, focusing on the families of children Dawn would not be pursuing a sporting been building blocks for my daily coping.” career she decided to focus on the wellbe- who had drowned in backyard swimming ing of others, and despite missing years of pools. Working with the Queensland Injury She cut off all the drugs she had been schooling due to ill health she went on to Surveillance Unit she was a key adviser in taking for years, including opioids. The gain a place at London University and com- drafting the pool fence legislation that was journey was not easy, as she confirms. a first for any Australian jurisdiction. pleted an undergraduate degree in psychol- Six years ago Dr Macintyre and partner ogy and education. On graduation, she was At the age of 50, Dawn decided to pursue a Neil visited the local area for a weekend offered the opportunity to pursue a doctor- PhD through the University of Queensland break, spotting a ‘For Sale’ sign on the ate, but she had become captivated by pet on the topic of the gaps in support for the Clunes property and driving onto the land.

12 | GPSpeak ‘Dog’s life’ takes on new meaning Northern Rivers doctors win NSW rural medical awards

As they gazed over the glorious landscape two white butterflies fluttered around her. “Families who’ve lost kids have said butterflies represented the souls of their children flying free. I said we have to buy this place, and we did, building our dream home and additional accommodation for the use of people who have experienced the loss of a child, or who need respite.” ‘Highland Retreat’ is also home to their four gorgeous oodle dogs, Charli, a spoodle and the only girl, cavoodle Dougal, labra- doodle Barnzy and groodle Riley. Oodles derive from original poodle stock and are as bright and engaging as their forebears. They provide wonderful companionship for Dr Macintyre who is now able to walk them with her husband most days and delight in taking the no-shedding, hypoallergenic The photo features (L-R): Dr Ian Falson from Ballina, Dr Mark Rikard-Bell from canines on visits to local dementia and aged Muswellbrook, Dr Delma Mullins from Muswellbrook, Dr Neroli Lawrence from South care facilities. Barnzy and Riley are larger Grafton, Dr Richard Abbott from Scone, Dr Peter Lee from Singleton, Dr Anil Thakur from dogs so can be patted without the need to Maclean and Dr Chris McKenzie from Ballina. Photo provided by NSW RDN bend down. “Thanks to these lovely creatures, and Northern Rivers GPs Ian Falson, Chris McKenzie and Anil Thakur are the rehab support I received last year, I among the regionally based doctors to win a prestigious 2018 NSW have many good days, while before I could Rural Medical Service Award. They were honoured for their long-stand- barely say I had good hours. Research has ing medical service at the presentation dinner hosted by the NSW Rural shown that pets provide owners with both Doctors Network in Sydney. psychological and physiological benefits and the majority are healthier than those The Rural Medical Service Award recognises GPs who have provided 35 years or without pets.” more of medical service to the people of rural, regional and remote NSW. The dogs have such a place in her heart Dr Falson is a GP proceduralist who has clocked up 38 years of medical service for that she has published the first of a series of the North Coast communities of Port Macquarie and Ballina. He has worked in the children’s books, Oodles of Fun, about their Northern Rivers since 1995, and has a special interest in primary care skin cancer personalities and antics. A percentage of medicine. He is a founding member of the Skin Cancer College of Australasia. the book’s sales go to the Story Dogs liter- Dr McKenzie has practised at Ballina Family Medical Centre for 35 years. During acy program https://www.storydogs.org. this time, he has provided VMO services to patients at Ballina District Hospital, au/ that brings young readers together with working both in the Emergency Department and medical wards. quiet companion dogs. Dr Thakur has been a surgeon and GP in Maclean since 1985. He has interests in While no one can predict the future, endoscopy, cosmetic surgery and skin cancer treatment. He was an early promoter of perhaps the discreet tattoo on Dawn Mac- computers in general practice. intyre’s inner wrist sums it up. At first it’s hard to spot as the dogs are so keen on Rural Doctors Network CEO Richard Colbran praised the significant contribution to crowding in to lick her hands. Years ago the their rural community by providing high quality continuity of care. Infinity symbol may have been a reminder “It is rare for rural doctors to be formally recognised for the outstanding contribu- that her pain would never stop. Now it must tion they make to their community and to be acknowledged for the work they do,” he surely mean she has a long and happy life ahead. noted. “Everyone’s pain journey is different, “This award provides a unique opportunity for the people of the Northern Rivers to and whilst for a long time I mourned the acknowledge the difference that Drs Falson, McKenzie and Thakur make to the health old Dawn, I now enjoy discovering the new and wellbeing of the community.” me,” she says, with a warm smile. Oodles of joy seem to lie ahead. GPSpeak | 13 Introducing North Coast Radiology Group are pleased to offer this service to all of your patients. They only need a smart phone for us to send the details to.

Link to images sent 24 hours after the appointment

Allows them to share with Specialists or family

Environmentally friendly with access from phone, tablet or computer

Reports sent to patient 7 days after the appointment

www.ncrg.com.au for more information

14 | GPSpeak Team work the key to better emergency care by Dr Charlotte Hall, Emergency Participants with extensive experience in medicine, nursing and allied health are Physician, North Coast NSW sharing their wisdom and demonstrating that, as they seek to improve their own Imagine a perfect work day in healthcare. human factor skills, learning is lifelong. You were part of a motivated and well-functioning team. Patient care had been the best Reducing the rate of errors in medical you could all deliver. Conversations with practice would save many lives a year and other healthcare workers were respectful prevent the misery suffered by those who and helpful. You had the chance to demon- survive a mishap. In the USA, medical error strate both your leadership and follower is the third leading cause of death. Sadly, skills and were able share your ideas and when a serious medical error occurs there sense of humour. is often a second victim. The healthcare worker involved in the case often assumes dispropor- tionate responsibility for the error, failing to recognise that the system they were working Dr Charlotte Hall in was a major contributor. In 2018 concepts from the ADEPT work- These feelings of isolation shop were presented to the NSW Health are often amplified by the in- Minister Brad Hazzard who showed great vestigation process and the interest and later organised and attended healthcare worker then loses a further meeting at the Ministry of Health confidence in their ability and with leaders of pillar organizations, includ- ultimately leaves their profes- ing the Agency for Clinical Innovation and sion or becomes so distressed the Clinical Excellence Commission. that they cannot function in their daily life. The next step locally involves expanding The Swiss Cheese Model of Accident Causation the training and professional development We are all too familiar with programs. GP leaders Dr Tony Lembke by Davidmack [CC BY-SA 3.0] those tragic cases where the second victim’s and Dr David Guest have identified that journey ends in suicide. So much more can human factors training is integral to the and must be done to support healthcare Your managers had granted you the au- provision of excellent primary health care. workers who find themselves exposed to tonomy to organize your own practice areas Most importantly barriers to communica- such enormous personal stress. Preventing and workflow. You felt supported by your tion between hospital and general practic- the error in the first place should become a colleagues and enjoyed a sense of job sees need to be torn down and replaced with high priority for our industry. We will never curity and mental well-being. You felt em- more effective models. Face to face dis- prevent all errors but that should not stop powered to call out bad or concerning be- cussion remains one of the most effective us from trying to eliminate as many as we haviours and knew that any serious adverse means of communication and GPs should can. events would be investigated by a team with be both known and welcomed within our expertise in human factors. Over the past five years rural generalist hospitals. Dr Dean Robertson and emergency physi- And so on… but can we really change the Mastery of human factors represents a cian/ educator Dr Charlotte Hall have col- culture of the medical workforce? Scep- catalyst for positive change in the culture laborated with senior pilots Mick Aspinall tics may think not, but the answer is “yes” of the healthcare industry. Here on the and Anthony Lock to devise and refine edu- according to graduates of the Advanced North Coast of NSW we are used to leading cational models for teaching human factors Emergency Performance Training (ADEPT) reform. Let’s add this one to our list. skills to health practitioners. Anthony workshop. Lock also works as the Director of Human Comments from previous workshop ADEPT teaches “human factors” skills Performance at the Royal Perth Hospital. participants and registration details can such as leadership, teamwork, communi- Local senior clinical nurse educators, Fiona be found at emergencyprotocols.org.au/ cation, assertion, conflict management, MacCallum, Sharene Pascoe and Michael ADEPT. Steenson have contributed their expertise self-awareness, situation awareness, and References decision-making. Armed with enhanced to the ADEPT workshops. skills and increased confidence, ADEPT Makary Martin A, Daniel Michael. Jana Ewing and Stuart James have as- graduates are already effecting positive Medical error—the third leading cause of sisted with program development and changes in their workplaces. Our newest death in the US BMJ2016; 353 :i2139 teaching. Surgeon Dr Sue Velovski and the generation of healthcare workers is enjoy- LBH Executive team led by Wayne Jones Albert W Wu Medical error: the second ing the opportunity to revolutionise one and Dr Katherine Willis-Sullivan have wel- victim The doctor who makes the mistake aspect of modern healthcare, the delivery comed and supported this reform initiative. needs help too BMJ. 2000 Mar 18; of critical care in life or death situations. 320(7237): 726–727.

GPSpeak | 15 Reflections of the retiring NCPHN Chair

Dr Tony Lembke retired as the General Practice Network (NRGPN). It was Chair of the North Coast Primary instrumental in the computerisation of Health Network in December 2018. general practice, where the North Coast is still a national leader. It supported immu- He looks back at his time with the nisation and accreditation. Our region had various primary health care support the largest participation in the Australian organisations from the early 1990s Primary Care Collaboratives, which fos- until today. tered innovation and collegiality. Not long after I joined the Alstonville We realised we were all dealing with the Clinic as a fresh young GP in 1993 my same issues and learnt to share generously senior partner Paul Earner suggested I and steal shamelessly. We ran the Family put myself forward to join the Board of the Care Centre in Lismore, managed the newly formed Northern Rivers Division of Nimbin General Practice, and auspiced the General Practice. establishment of Bullinah and Jullums Ab- original Medical Services. GP Speak became I think his precise words were ‘Make sure a voice of the local medical community. they don’t bugger things up’. Among many, Katherine Breen-Kurescev The Lismore Base Hospital Department - whose tremendous skill and wisdom I re- of General Practice was already very active member her very fondly - Chris Clark, Sue at this time, and nearly all the Lismore and Page and Andrew Binns were especially im- Dr Tony Lembke Alstonville GPs were VMOs. More than half portant to the Division. the patients admitted to LBH - including In 2015, 62 Medicare Locals became 31 obstetrics - were under the care of GPs. We From General Practice to Primary Primary Health Networks. We were suc- all tended to run into each other each day Care cessful in retaining our boundary and in on the wards, and every week we met at In 2011, the government ceased funding retaining management under the auspices breakfast in the hospital cafeteria. On the General Practice Networks in favour of of the company Healthy North Coast. This menu was cold toast, bad coffee and a clini- larger primary care organisations - Medi- transition required a considerable amount cal presentation. care Locals. 128 Divisions became 62 MLs. of focus and a loss of momentum. I hope The new Division of General Practice Medicare Local contracts were awarded to that the PHNs will now be given the space had members from further afield - Ballina, independent companies to provide specific to consolidate their roles. Byron, Kyogle, Bonalbo, Casino, Evans services on behalf of the federal Depart- The PHNs have funding to support Head, Coraki, Ocean Shores and Nimbin. ment of Health. general practice and other primary care The first edition of GP Speak was in No- The NRGPN, in partnership with our providers, and also to promote local in- vember 1994 . This journal reminds us that colleagues in the Tweed Valley, Mid North tegration of health care. They have a very the management committee at the time Coast, the Hastings Valley (and North specific role in assessing local needs and comprised Hilton Koppe, David Guest, Coast GP Training) and Many Rivers Alli- in commissioning services to meet those Chris Mitchell, Jane Barker, Christine ance formed the company ‘Healthy North needs. Gestier and myself. David Helliwell ran the Coast’. We were successful in a competitive Nimbin Drug and Alcohol Service, Brian tender to manage this new entity. A Seat at the Table Witt managed the Early Intervention for A major result of these organisational Alcohol Abuse program, and Hilton Koppe The NRGPN was able to retain funds that changes is that general practice and primary ran the inter-practice visits program. We it had acquired independently on behalf of care now have an established seat at the should do that again! David Guest was re- the general practice community and has table where health decisions are made - in sponsible for IMIT, and we were famous for been able to continue to operate since that Canberra, in Sydney and especially locally. open source principles and promoting Tux time. The long-lasting GPSpeak is one of its the Linux penguin. ongoing achievements. The model of the Person Centred Health System, centred around a ‘medical home’, is Our mission was to make it easier for our The Medicare Local, owned by the com- well established and accepted at the highest GPs to deliver the high-quality care they munity and clinicians, has the aim of ensur- levels of state and federal government. In aspired to. This has remained a core goal ing each person could access the care team this model, a patient and their family have during the various iterations of the local that they need, that this care would be of an ongoing relationship with a particular primary care organisations that have fol- high quality, and it would be joined up. I GP, supported by a high functioning general lowed. believe that because the Medicare Local in our region was auspiced by general practice practice team, and the rest of the health ser- The Division organised educational it was better positioned to retain a focus vices wrap around this partnership. events and social occasions. Do you re- on grass roots care centred around the re- Patients experience ‘joined up’ care. Our member the car rally to Broken Head, the lationship between a patient and their GP. region has been instrumental in advocating weekend events at Couran Cove, the family This was not always the experience nation- for this model, and it is finally becoming event at Sea World? ally. rare for state and federal health strategies The Division became the Northern Rivers to ignore general practice.

16 | GPSpeak In our region we now see joint planning it can be invisible when they do - when a The future between the Local Health Districts and discharge summary doesn’t arrive it stands People in our community need better the PHN. The Winter Strategy resources out, yet is invisible when it does. health care. Our clinicians want to work in a general practices to be proactive in man- When I look at how I practice now, com- system that enables them to deliver the best aging high risk patients, supported by the pared to when I started, some of the great- possible care. Our nation needs care to be Northern NSW LHD. We have a Healthy est successes that have been supported by efficient and effective. Towns program that is bringing together the Division/PHN would include:- primary and secondary health, local council I believe the NRGPN continues to have and social providers to develop innova- Practice Nurses a vital role and I particularly acknowledge tive solutions to local needs. We are at the the work of David Guest, Nathan Keste- Practice nurses are an integral part of the forefront of models for shared investment ven and Andrew Binns as custodians. I way we deliver care, forming a three-way between state and federal governments, think we had more collegiality as GPs and team with GP and patient. They have more private companies, and social services, in- medical specialists 20 years ago and the independence, and we wouldn’t manage cluding education and justice, and other NRGPN remains well positioned to foster chronic disease, wound care, immunisation community services. our coming together socially and to guide and acute illness without them. They have a professional development opportunities. There are now regular meetings at every strong supportive network, and are forming level - board, executive and management - cooperative teams with community nurses. The NRGPN has an important role as one between the LHDs and PHNs - and I cannot of just a few ‘owners’ of the PHN, and clini- Information Technology imagine any major initiatives that would cians have the opportunity to participate in not be a partnership. This is unique nation- I started in a paper-based world. It is sur- the clinical councils or as special advisors in ally. prising to remember how poorly we tracked the commissioning process. medications and patient summaries, and Vahid Saberi and Dan Ewald require The funding available to the PHN is an the amount of work in writing letters, special acknowledgement for their vision order of magnitude higher than that re- repeat prescriptions (especially for nursing and passion in developing the PHN. And I ceived by Divisions of General Practice. homes) and processing incoming letters have had the honour of working with Linda More than $20 million is available each and results. Discharge summaries are now Muscat, Leanne Tully and Marika Ilic for year for commissioning the services that timely and legible. A central health record the whole 20 years! our community needs. As clinicians I is available, and the hospital has begun to believe we have a responsibility to ensure it Our second jobs upload key results and events. I can com- is allocated effectively and efficiently for the municate with a patient’s care team elec- The first job in health care is the face-to- benefit of our patients. tronically - for the most part anyway. This face interaction that clinicians have with is still a work in process. With our participation, we can build a their patients. What a privilege. Person Centred Health System by ‘focusing Mental Health The second job is to improve the systems north’. Underpinning every time we see that enable us to deliver care, such that the Mental health has become a highly signif- a patient, every meeting we attend, every next patient has a better outcome and ex- icant proportion of the care we provide. We paper and email we write, every service that perience. have many more tools at our disposal, in- is commissioned lies the question: how will cluding youth health services such as Head- this activity change the way an individual It is easy as a doctor to think that the only space, psychologists, suicide prevention person uses their hands, feet or mouth to one doing any real work is oneself. support services and geriatric services. Un- create a richer, more meaningful life for I have developed a tremendous admira- fortunately, as the demand is growing, and themselves? tion and respect for those clinicians and being identified, there is much more to do. Tony Lembke was an RMO at non-clinicians who work in this second role Chronic Disease Management - many of whom are part of the PHNs and Lismore Base Hospital 1990-1992. He LHDs. I understand that this ‘second job’ CDM now makes up more than 50 percent has worked at the Nimbin Medical - success in improving systems - is just as of general practice. We have become much Centre, Lismore Clinic, and Keen St essential in achieving our health aims as the more proactive, systematic and team based. Clinic. He has been a partner at the role of clinicians. We have resources available to us in the Alstonville Clinic since 1993. He was community that facilitate the real work - a director of the NRDGP 1994 - 2012, Engaging with busy GPs was one of the that done by our patients and their families greatest challenges for the Division of serving as chair from 1999. He was at home. General Practice, and remains even more inaugural chair of the North Coast so for the PHN. I am aware that many GPs Work/life balance Medical Local (2012-2015) and then considered the Division a waste of money chair of the North Coast Primary It seems to me that improved systems and and the PHN even more so. Health Network (2015 - 2018). He better workforce has given us more time Progress is slow, many of the achieve- with our family. Certainly the after-hours was a director of the Australian ments are behind the scenes and not load is much less, and we have more days General Practice Network and the ‘branded’; frustrations have not been fully allocated off each week. University of Sydney’s Donkey Kong resolved; and systems are incomplete. It is champion in 1993. easy to notice when things don’t work and

GPSpeak | 17 From the French queen’s boudoir

In suitable proximity to Lismore Region- on the loom in Lyon that was used to make “I felt that if I could see and touch such al Gallery’s exhibition on the anti-log- the original 17th century material, later de- pieces I would be able to understand how ging campaign at Terania Creek stands stroyed by time. they were made and even match their The Hannah Cabinet, constructed of rare quality. It was a long time ago, no white Geoff was given a swatch in 1980 when timbers (many of them recovered or recy- gloves were required!” he visited the restoration workshops at the cled) and containing 14 secret compart- Versailles Palace while researching early Viewing The Hannah Cabinet, and ments. cabinet making techniques in England some of his other astounding creations, “Before the advent of metal safes you and France. Access to France’s treasures it is clear that he has achieved this goal. would conceal valuable items in hidden was helped by letters from local MP Bruce “You could spend a day or even a week spaces within furniture,” its creator Geoff Duncan and then-NSW Premier Neville with the cabinet and never unlock its Hannah explains, saying one such space Wran. The 30-year-old woodworker from secrets,” Geoff chuckles, “but I will reveal in this masterwork holds a sliver of silk Lismore was on his way. all to the ultimate purchaser, which will brocade from the inner sanctum of the “The fabric was presented to me by the hopefully be our own gallery.” bedchamber of Marie Antoinette (1755- chief ebonist [a worker in ebony or other 1793), itself a secret place. The 30-minute video by filmmaker decorative wood] after I spent some time Ross Bray and cinematographer Steve Featuring some of the executed queen’s studying the magnificent Bureau du Roi, Munro was produced by local business favourite motifs - roses, butterflies and the rolltop desk made for Louis XV. owners Brian Henry and Gaela Hurford. tiny lattice-work - the fabric was woven Without a trace of hubris, Geoff adds,

Geoff Hannah holding a portion of the silk brocade from Marie Antoinette’s chamber, in front of one of his superb creations. Another section is secreted in The Hannah Cabinet.

18 | GPSpeak The Hannah Cabinet is two-thirds Lismore’s

Already $650,000 has been raised to keep Geoff Hannah’s masterwork in Lismore. Let’s raise the bar to $1.0m and celebrate one of the world’s best-ever pieces of furniture staying in the place where it was created. In the past thirty years Lismore sored,” said Brian Henry, another master craftsman Geoff Hannah has member of the Acquisition Team. created five magnificent timber cab- “The value of the drawers range inets, with this one, known simply from $5,000 to $100,000 and as the Hannah Cabinet is undoubt- sponsors receive formal recog- edly the finest, largest and most nition and are offered a private technically accomplished of them viewing,” he said. all. “To date we have raised over With a passion for 18th and $360,000 locally and the NSW 19th century furniture Geoff was State Government was so im- awarded a Churchill Fellowship pressed with the local response in 1980, travelling to Europe to and recognised its unique value, examine the intricacies of iconic not only to the local region but pieces in the Victoria & Albert to Australia, that they donated Museum in London, the Louvre in a further $250,000.” As well Paris and the Palace of Versailles. as being awarded the Churchill Fellowship, Geoff was made an “Two local doctors played a role Honorary Fellow of Southern in undertaking this once in a life- Cross University in 2009 and was time experience,” said Geoff. awarded an OAM in 2018 for ser- “Dr Nick Kerkenezov encouraged vices to the visual arts. me to apply for the Churchill Fellow- A public opening of The Hannah ship and whilst away on the three Cabinet takes place every Wednes- month study tour it was Dr John day at 10.30am and every 4th Chadwick and his wife Josanne who Sunday at 11.00am at the Lismore regularly kept in touch with Rhonda Regional Gallery. [Geoff’s wife] and the two kids, and took them on weekend getaways.” For more information about making a tax deductible donation In 1988 Geoff displayed his first or pledge please contact Brian intricate marquetry cabinet, The Henry on 0428 251834 or Gaela Bicentennial Cabinet, which was Hurford on 0419 868 678, or visit first exhibited in the Sydney Opera multiple drawers and a further 14 doors in www.hannahcabinet.com. House. The Yarralumla Cabinet followed in tiers decorated with veneer inlays of birds, 1991 and was purchased by the Australiana bugs and flora. Several secret drawers have Fund for the Governor-General’s residence not been seen and will only be revealed to in Canberra. In 2000, while visiting the the ultimate purchaser. Olympics in Sydney, a Belgium business- man recognised Geoff’s outstanding talent “Geoff’s cabinets go beyond the realm of and quickly bought the third cabinet, The furniture and the Lismore Regional Gallery, Australiana Cabinet, shipping it back to his like Bungendore Wood Works Gallery international headquarters on the Grand before it, recognises the iconic status of Place in Antwerp. his work and in particular the importance of The Hannah Cabinet to the Lismore Then came The Hannah Cabinet, rich region and Australia,” said Gaela Hurford, with its complex marquetry, parquetry, a member of the Acquisition Team. 17 varieties of semi precious and precious stones, rare shells and even a piece of Ma- On behalf of the Lismore Regional Gallery rie-Antoinette’s silk brocade border from the group has taken on the challenge of her Versailles summer bedroom. raising $1.0 million to purchase this magnificent piece for the gallery’s permanent More than six years in the making it in- collection. It would also be made available cludes 34 different types of solid timbers for short periods to travel within Australia and veneers, with the main frame being ma- for specific exhibitions. hogany and the six columns carved from the one solid piece of ebony wood. The Hannah “We have come up with a unique way of Cabinet has a treasure trove of secrets to raising money to purchase the cabinet by divulge. Four tall front doors open to reveal allowing 92 of the 140 drawers to be spon-

GPSpeak | 19 The Hannah Video

As part of the promotion to raise funds for the retention of the Hannah Cabinet in Lismore local filmmaker Ross Bray and cinematographer Steve Munro have produced a 30 minute film on the cabinet and its maker Geoff Hannah. The film produced by local business owners Brian Henry and Gaela Hurford covers Geoff’s upbringing and family life and his early courting of his wife Rhonda since first meeting in their teenage years. Geoff tells of how he started in woodwork with local firm Brown and Jolly’s where he developed a love for his craft. His unique ability was recognised at an early age and in his early thirties he travelled to England and France on a Churchill Fellow- ship to increase his knowledge in the esoteric field of 17th century cabinet making. Geoff’s humble approach to his work is inspiring and shows what a life of dedication can achieve and is an example to us all. The film with bring a tear to the eye of nearly all viewers. For those for whom it does not, they can assuage their lack of feeling by buying a drawer as part of the fund raising effort.

Homelessness is a hidden blight that needs healing

Homeless, homeless will ever find work again, whatev- Moonlight sleeping on a midnight er their backgrounds. lake In the lead-up to the NSW elec- - Homeless, from Graceland album tion, the Berejiklian government by Paul Simon joined with NGOs to launch a plan to significantly reduce street sleeping, the most publicly em- Venture out any night to the picnic grounds, barrassing sign of homelessness, car parks, beach dunes and sporting fields but as with so many initiatives in and around any Northern Rivers town – the focus was Sydney rather than Byron Bay, Ballina, Lismore, Casino… the non-urban areas. The challenges list goes on – and you’ll see people sleeping in our backyard are similar yet rough. Some will be in park shelters, others Living out of a car is one of the ways homeless people find shelter for unique, not least because we lack in their cars or vans, huddled in alcoves in the night services such as night patrols town, in single tents issued by welfare agen- and emergency accommodation. cies or under tarps strung between trees. The reality unseen to most of us is that seven local government areas on the NSW The medical challenges of assisting There’s nothing romantic about “moon- North Coast – Byron Shire sits at #1 - record homeless people will be well known to light sleeping on a midnight lake”, espe- the greatest rental stress levels (at least doctors – extreme co-morbidity, the diffi- cially when the weather is wet or cold, one-third of household income needed to culty of arranging follow-up appointments, let alone when you’re fearful of being as- pay rent) of the top eight in all NSW, which the risk of patients losing (or having stolen) saulted, even sexually assaulted, or having includes the cities. And as a consequence, medications or not following dosage time- your meagre possessions stolen by other we have the state’s worst homelessness tables. Many GPs outreach to services as- homeless people, possibly affected by sub- crisis. sisting homeless and/or vulnerable people, stance misuse or mental health issues, or by including Aboriginal community members, As well as high rents the problems someone out to have ‘fun’ at the expense of but the challenges are great. the vulnerable. include rentals being converted to Airbnbs, forcing people to move out and away, and Having access to proper accommodation, Primary homelessness, as it’s known in the upward pressure on caravan park rates whatever one’s status in life, is a fundamen- the business, is just the tip of an iceberg during holiday seasons, which are now tal human right and a core foundation of below which lie many more people moving almost year-round. Maslow’s well-known hierarchy of needs, from one accommodation to another, for yet so many people cannot achieve it, or Public housing wait lists are long, and example refuges or ‘couch surfing’, or living worse, are being denied it through no fault only minimal construction or conversion in boarding houses and budget caravan of their own. This is certainly an indictment is taking place. Support centres such as the parks. Many are young, not least because of of our society but on a positive note might Winsome & Lismore Soup Kitchen which the paltry Newstart allowance, but others be seen as a spotlight on where our priori- has some accommodation, are inundated are parents, often solo with young children, ties should lie. while older women are a demographic by daytime visitors seeking food, company whose numbers are rising. and referrals to services. Many have mental health and other issues, and few - Robin Osborne 20 | GPSpeak Book ReviewBook Review - the Social Leap

“Preferences that don’t fit your abilities and thus are as debilitating as limbs that don’t suit could poten- your lifestyle… our bodies changed a little tially give over the last six or seven million years, but them new our psychology changed a lot.” diseases… so we developed How this affects matters as diverse as psychological world peace and the relationship between adaptations our happiness and our health, he discusses to disease in riveting fashion, crafting a narrative that threats that holds equal appeal for both general and are collec- specialist readers, not to mention corporate tively charac- chiefs whose competitive behaviour is en- terised as the tertainingly, and accurately, compared to behavioural African baboons. immune “Baboon leaders are particularly moti- system… vated by the enormous status, power and “People who found other people’s open financial reward of being a CEO”, he writes, sores interesting or attractive were far juxtaposing the animal and its human less likely to survive and have children of counterpart with elephants and the rest their own, and thus evolution ensured that of us whose characteristic behaviours are our disgust protects us… by regarding be- largely collaborative. haviours different from our own as wrong “Once we moved to the savannah and or immoral, we tend to stay away from found that cooperation was the key to people who engage in those behaviours, Reviewed by Robin Osborne success, we had the good fortune that group which protects us from them.” goals and individual goals aligned for the Similarly protective, if internally based, first time in the great apes… [this] eventu- is the close relationship between personal The Social Leap ally brought us to the top of the food chain, happiness – a quality not dependent on our despite the conspicuous absence of any bi- How and Why Humans Connect material purchases, as he stresses – and our ological weaponry beyond our large brain.” immune functioning: William von Hippel Hence, the great “social leap” and our exit “Our immune system evolved to hum Scribe 304pp $29.99 from Africa. along at peak capacity when we’re happy A myriad of books discuss who and what “It was our capacity to learn from the ex- but to slow down dramatically when we’re we are, and why we behave the way we do. periences of others that gave Homo sapiens not. This is why long-term unhappiness can From Darwin to Dawkins, human genetics an enormous local advantage… each gener- literally kill you through its immune-sup- and behaviours have gone under the micro- ation had no need to reinvent the wheel.” pressing effects, and why loneliness in late scope, and it is hard to imagine what mys- adulthood is deadlier than smoking.” The book enters fascinating territory teries remain to be uncovered, apart from when von Hippel considers the psycholo- A study of older people showed that they the causes and possible cures of many ill- gy behind technical innovation, pondering remembered positive images (baskets of nesses. why some people innovate new products puppies) much better than negative ones Yet William von Hippel has compiled a while most people don’t, and exploring (plane crash scenes), and this memory focus highly original and enjoyable account of what he terms the “social innovation hy- was closely linked with higher CD4 white human evolution and its inextricable rela- pothesis”. blood cell counts, which indicates a greater tionship with our psychology. preparedness to fight off disease: “In other Based on extensive studies, he suggests words, the more positive their memories Professor von Hippel grew up, studied that while almost all humans are innova- were today, the healthie they were next and taught in the US before “finding his tors, people with a more social disposition year and the year after… by focusing on the way” to Australia, as his bio puts, and later direct their inventive capacities towards positive aspects of life, we enhance our own becoming a professor of psychology at the socialising rather than invention. Further, immune functioning.” University of Queensland. Extensively pub- “Professions oriented towards technical lished in the mainstream and academic solutions (e.g. mathematics and engineer- This is one of his ‘ten easy steps’ for a press, this is his first full-length book, and a ing) boast many more people in their ranks better life. Others include living in the cracker it is, although hardly the “rollicking who are not only on the autism spectrum present, cooperating with family, friends tour through humanity’s evolutionary past” but are predominantly male.” and colleagues, learning new things, accu- that one reviewer suggested, if for no other mulating “experiences not stuff”, and pri- Apple’s Steve Jobs comes to mind. reason than a good deal of it is set in the oritising food, friends and sexual relation- present. Equally intriguing is his exploration of ships. how humans evolved to cooperate within “We tend to think of evolution in terms of Sounds a good recipe for continuing our but not between groups, citing how “our an- anatomy, but attitudes are just as import- social leap forward. cestors also faced the risk that other groups ant for survival as body parts,” he writes. had been exposed to different pathogens,

GPSpeak | 21 Youthful understanding of local Country

Every child from everywhere Cover illustration by have rights to learn Grace (aged 5) from Lismore Preschool, on in their way from their place photograph taken at it’s their turn Banyam Baigham by Rob Garbutt. valuing what they give and bring - Every Child (Monkey & the fish) Cover design by Leonie Lane.

tivist that uses self-directed, experiential learning in relationship-driven environ- ments. “The project began with educators as learners - listening to and learning from Aunty Thelma James and Aunty Marie Del- bridge; Will Davis from SCU’s Gnibi, from Country itself, from our readings and from each other through sharing experiences and exchanging ideas over many meetings.” Elders visited early childhood centres to share stories, song, ochre, dance and food, meetings were arranged with Bundjalung knowledge keepers and artists, children visited special sites, the Gallery (where Digby Moran’s acclaimed work was on show), the city and the river. “The aim was to enable children to know the place where we live, learn and play, and work.

At the launch of ‘Growing up on Widjabul Wia-bal Country’ were (l-r) Sarah Black from Friends “Through all these experiences young Child Care Centre, Shauna McIntyre, project coordinator, Lynette Funnell Lismore Pre School, children and jarjums, supported by their Elder Aunty Thelma James, and sisters Audrey (aged 7) and Eliza (5) Zwiers who have Wiradjuri passionate educators, used their senses, heritage through their father. intelligences and capacities to make and express their own meanings of what they The meeting room at Lismore Regional local Widjabul Wia-bal Country, part of the were experiencing and learning,” Ms McIn- Gallery was packed with Aboriginal Elders broader Bundjalung Nation. Birds, koalas, tyre said. and community members, representatives goannas, turtles, trees, waterways, and the from funding bodies (including YWCA, natural landscape come alive through the “All these learning strategies were care- Southern Cross University, Lismore City children’s eyes and imaginations, enhanced fully documented by their dedicated group Council), early childhood educators and, by guidance from the Elders as well as their of educators by recording children and most especially, young children and jarjums educators. jarjums words, their artwork and taking (children in the Bundjalung language), who photos of their play. Shauna McIntyre, project coordinator had participated in this remarkable project. said that while the children and jarjums are “This book is told largely through the The book launch began with a Welcome the book’s “main authors”, the project was fresh voices and artwork of some of Lis- to Country by Widjabul Wia-bal Elder an early childhood education and cultural more’s youngest citizens… it is not only for Aunty Thelma James, a key member of project inspired by Widjabul Wia-bal Elders the jarjums, children and their families – it the coordinating team, and included a and Country of the Bundjalung Nation and will be also offered to the community as a live performance of the song Every Child the world renowned early childhood educa- contribution to the contemporary culture of by local artists Chris Fisher and Marcelle tion practices from Reggio Emilia, North- the city and to our collective efforts towards Townsend-Cross, a.k.a. Monkey & the fish, ern Italy. children and jarjums experiencing them- well-known in the Bundjalung community. selves as belonging to a community for The Reggio Emilia approach is an educa- children, in Lismore, on Widjabul Wia-bal The 44-page book features artwork by tional philosophy focused on preschool and Country of the Bundjalung Nation”. preschoolers, Aboriginal and non-Aborigi- primary education. It is a pedagogy de- nal, depicting features and creatures of the scribed as student-centered and construc-

22 | GPSpeak Bundjalung upgrade for Goonellabah hub

There’s nothing like an impending election, especially in a marginal seat such as Lismore, to attract much-needed funding to community projects, and proof positive came with the NSW government’s grant of $100,000 to help transform one of the most socially challenged precincts of Goonella- bah. The retiring State MP for Lismore, Thomas George, was represented at the launch event by his aspiring Nationals suc- cessor Austin Curtin, son of the eminent local surgeon of the same name. Managed by successful tenderer and lead agency North Coast Community Housing (NCCH), the project kicked off in late January with the commencement of striking artwork by Bundjalung painters Gilbert Laurie and Luke Close, assisted by local Ab- original children.

NCCH representatives came together Bundjalung artists Luke Close (left) and Gilbert Laurie with (l-r) Georgina Cohen, Manager with the artists, community members, and Integrated Care Team - Rekindling the Spirit, St Vincent de Paul Society’s Special Works Manager, other participating organisations, including Linda Williams, North Coast Community Housing’s Chair Robyn Hordern and CEO John McKenna, Lismore City Council, PCYC and Lismore Senior Constable Lismore Police David Henderson, PCYC General Manager Greg Ironfield, and Lismore City Councillor Darlene Cook. Police, NSW Health’s HIV and Related “This is the first unfolding of a much larger $100,000 project that will see the re- development of this area into a safe hub for young people to express themselves,” said Robyn Hordern, NCCH Chair. “It was really important to us that local young people are invited to be involved because this is all for them. It allows them the opportunity to create their own sense of place in the space they call home.”

Programs (HARP) and St Vincent de Paul the sunset goal, it will cause them to reflect Lismore. on the decisions they made that day,” Luke said. The first phase entails an extensive upgrade of Elders Memorial Park, a well- A short stroll up the road, the rear wall treed but neglected area, beginning with a of the Coles supermarket has been painted revamp of the basketball court that will be with a giant mural featuring symbolic resurfaced, painted blue and fitted out with Bundjalung designs interpreted by Gilbert hoop backboards featuring sunrise and Laurie, a cultural custodian, helped by a sunset designs by Luke Close. Park furni- group of willing jarjums (chidren). ture, towers and street lighting will also be Another component of the broader added. project is the installation of a disposable “I hope that when young people score a sharps container to help reduce waste and goal in the sunrise goal, and then a goal in encourage responsible syringe use.

GPSpeak | 23 10 important tips for business owners

As a business owner, there is always something to do, however many owners often spend more time working in the business than they do on the business.

Here are ten simple management tips to help you maintain a successful business in good and not-so- good times.

1. Watch trends in your industry. Compare your business performance with your competitors and to performance in previous years. 2. Review your market and your sales/marketing plans at least every three months. 3. Review your financial management. Timely discounts? Or if you are unable to pay an accurate reporting is vital to the success of any account in full by the due date, talk to the business. supplier and make arrangements to pay it off. 4. Ensure your budgets are current and regularly Keep the communication open and honest and reviewed. If profit falls below what you had fulfil your promises. budgeted, prompt action is essential to reduce 8. Review credit facilities with your bank. Are there costs or boost sales. better options available that could save you 5. Align your business development plans with your money? budget. Ensure they are practical and won’t put 9. Check inventories and ensure your stock any undue pressure on your profit margin. If you turnover rate is at least equal to industry can’t afford to do or buy something now, standards. postpone it to when you know your business will 10. Above all DO IT NOW! If things look bad, take be in a better financial position. action to correct the situation. Look for positive 6. Ensure credit control is tight with prompt follow- approaches to solving any problems; and for up of overdue accounts. Make sure that your new opportunities to build your business. clients are aware of your trading terms upfront and if you have any concerns, discuss it first or refer them elsewhere. No clients are better than These all sound pretty simple, but in the day-to-day clients who can’t pay. running of a business it’s easy to let the simple things 7. Review your payments policy. Are you taking slide. For your peace of mind and success, allocate maximum advantage of prompt payment time to these important tasks.

Please contact TNR if you have any queries from the above information or if you have other queries regarding your financial affairs. ‘Scale-C’ is a new pinnacle of hepatitis C treatment

After three decades of problem for some of these people. groundbreaking Hep C treatment But what if there was a simple finger in Australia, a new research project prick test that could enable diagnosis and is focusing on ways of expanding treatment with a prescription in a matter Hep C care for Indigenous people. of hours? This would certainly increase Andrew Binns explains. the chance of successfully treating a person with chronic Hep C infection. In 1996 the then-Northern Rivers Division of General Practice received The news on this front is encouraging, funding for a Hepatitis C shared care with such a test now being trialled at project. At the time there were 20 new different sites around four of Australia’s notified cases of hepatitis C (Hep C) each the potential for HCV elimination in Aboriginal Medical Services (AMSs). month, according to a GPSpeak article by Australia. With high cure rates (sustained Jullums AMS, opposite Lismore Base Dr Jane Barker, the Project Manager. virological response [SVR] >95%) after Hospital, is one of those. It provides a 8-12 weeks treatment, HCV DAAs provide primary care GP service to residents of Interferon was one of the drugs used the tools required to reverse the growing Balund-a, a diversionary NSW Corrective for Hep C treatment. It was given over burden of liver disease and strive for HCV Service facility. The residents are young a 6-12 months period and for some had elimination. men who have come through the custodial unpleasant side effects. The waiting time system. In addition testing at Jullums will to see a gastroenterologist for treatment The Hep C Virus (HCV) disproportionately be available for all patients who are at high was quite long and GPs were encouraged to impacts vulnerable populations, including risk of having acquired Hep C infection. share the care to reduce the workload of the Aboriginal and Torres Strait Islander This research project, known as Scale-C specialists involved. people, injecting drug users, and people in custodial settings. In 2015, an estimated ,commences in April 2019. The Richmond area had the highest 227,306 Australians were living with It is being run until 2022 by the Kirby notification level on the North Coast, chronic HCV, including over 22,000 Institute and the South Australian Health with 640 cases in 1995, the year before Aboriginal people, with a growing burden and Medical Research Institute, with the project launched. It is believed this of HCV infection and HCV-related liver funding from the National Health and reflected the high use of intravenous drugs disease. While Aboriginal people account Medical Research Council. The aim is in this area, or the movement to this area for 2-3% of the national population, it is to develop an integrated model of care of IV drug users from urban areas, e.g. estimated that 8-10% of all Australians that increases access to HCV testing and Sydney, Brisbane, Gold Coast. living with HCV infection are Aboriginal. treatment for those who need it most. In 2003, after years of lobbying, the GPs play a vital role in identifying According to Professor Gregory Dore, then-Northern Rivers Area Health Service and managing those with chronic Hep C who leads the Hepatitis Clinical Research secured funding to establish the area’s first infection. Most of these regular patients program at the UNSW Kirby institute, Liver Clinic (in Lismore) for treatment have now been treated and the Liver Clinics around 60,000 Australians have been of Hep C. This facilitated access to much- are doing less initiating of Hep C treatment treated since 2016 with the highly curative needed treatment for many patients, than in past years. GPs are now able to therapies and now for the first time we are especially those on low incomes who were prescribe on authority script the DAA seeing fewer people dying of hepatitis C- less able to travel for treatment. medications once the appropriate testing related causes. The Liver Clinic provided a detailed has been done. Prof Dore’s data has also shown the assessment of the patient, including liver The challenge in the attempt to eliminate prevalence of HCV among people who biopsy, education and treatment. Some GPs Hep C is to access those people in the currently inject drugs had declined from were trained to become S100 treatment community who are maginalised, whether 43% in 2015 to 25% in 2017. prescribers for Hep C medications in a in the custodial system, experiencing shared care model. homelessness or for whatever reason Whilst this is an enormous advance in controlling the epidemic there are still At the time the combination of pegylated have not come forward for this lifesaving 170,000 people in Australia living with interferon and ribavirin for Hep C patients treatment. This may mean accessing those chronic Hep C. Moreover, there has been a (a once weekly injection) resulted in cure with Hep C infection through medical recent drop in treatment uptake that needs rates of at least 80% of patients with services for Aboriginal people, homeless to be addressed in order to meet the WHO genotype 2 or 3 and about 50% for patients people or those in custody. elimination targets of reducing deaths by with genotype 1. One of the issues when working in 65% and new infections by 80% before So where are we up to with Hep C these facilities is that, according to Hep C 2030. treatment 16 years later? treatment protocols, there are many steps required during testing and follow up visits Encouragingly, Prof Dore believes Oral direct-acting antiviral (DAA) to a GP. As so often within an itinerant Australia is in a good position to meet treatments introduced in 2016 have population, patients are lost to follow up. these targets, and if the experience of revolutionised the management of HCV Compliance with a full course of treatment recent decades is anything to judge by, the infection and given rise to optimism about which lasts for 8-12 weeks can also be a prospects do look bright.

GPSpeak | 25 Excellence in pathology Northern Rivers

Sullivan Nicolaides Pathology Lismore Laboratory Comprehensive pathology services across multiple disciplines 24-hour on-call service at St Vincent’s Private Hospital Collective expertise of scientists and specialist pathologists Serving the evolving needs of the region, employing more than 100 local staff Supporting and training new generations of medical scientists Backed by state-of-the-art facilities in Brisbane Meet your local pathology team

Dr Sarah McGahan MBBS FRCPA [email protected] (02) 6620 1203 Dr Sarah McGahan is Pathologist-in-Charge of SNP’s Lismore laboratory. A graduate of The University of Queensland, she trained in pathology at Royal Prince Alfred Hospital, Sydney. In 1995 she moved to northern NSW, where she worked at Lismore Base Hospital for 13 years, joining SNP in 2008. She has expertise in a broad range of histopathology including dermatopathology and gastrointestinal pathology, and has a particular interest in melanoma.

Dr Andrew Mayer MBBS(Hons) FRCPA [email protected] (02) 6620 1204 Dr Andrew Mayer has expertise across a broad range of general surgical pathology with particular interests in breast, gastrointestinal and dermatopathology. He graduated with honours from the University of Sydney in 1989 and went on to one year of forensic pathology training at the NSW Institute of Forensic Medicine, followed by five years in anatomical pathology training at the Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital.

Dr Juan Ortiz MD FRCPA [email protected] (02) 6620 1202 Dr Juan Ortiz completed his medical training in Colombia before moving to Australia where he undertook specialist training in anatomical pathology in Brisbane. There, he developed his interests in dermatopathology and ophthalmic pathology. He worked in private pathology in Newcastle before undertaking a one-year clinical fellowship in ophthalmic pathology at the Houston Methodist Hospital, a leading residency training hospital in the USA.

SULLIVAN NICOLAIDES PTY LTD • ABN 38 078 202 196 • A subsidiary of Sonic Healthcare Limited • ABN 24 004 196 909 24 Hurworth Street • Bowen Hills • Qld 4006 • Australia • Tel (07) 3377 8666 • Fax (07) 3318 7409 • PO Box 2014 • Fortitude Valley • Qld 4006 • Australia www.snp.com.au

26 | GPSpeak Getting food facts back on the table by Robin Osborne The ‘current’ policy, if such can be said of a 1992 document yet to be In a report whose recommendations are revised, was followed by a govern- unlikely to gain traction until after the ment-commissioned Scoping Study federal election, and perhaps only then if in 2013, made public three years later the Coalition fails to regain office, the Di- only after a Freedom of Information etitians Association of Australia is leading a request. push to thoroughly update the 26-year-old National Nutrition Policy. The policy was blighted from the start, a victim of food politics, charac- Alarmed by the impacts of poor diet on terised by claims of nanny state-ism preventable chronic conditions the DAA and intense lobbying by the food in- has launched the Nourish Not Neglect dustry. Battlegrounds included junk an advocacy document aimed at ad- report food advertising in children’s televi- dressing Australia’s $70 billion p.a. bill for sion time, ‘traffic light’ food labelling, chronic illness. sugar taxes, and doubtful ‘ticks’ of ap- Despite this unaffordable situation, the proval by certain health organisations. National Nutrition Policy has not been The issue may be a gift that keeps on updated in more than a quarter-century, giving for investigators at Choice mag- during which time Australia has slipped azine and ABC’s The Checkout, but from being a “global leader” in dietary in- there’s been little value to consumers, fluenced health practices. which is all of us: within five years it is predicted that 83 per cent of men and 75 per cent of women will be over- weight or obese.

“To address Australia’s growing development, implementation and health and societal issues, the Austra- evaluation strategies. lian Government needs to develop, fund and implement a new National Nutrition These include appointing an expert over- Policy,” the DAA report urges. sight group and external consultants to develop the National Nutrition Policy, the “Not only will this reduce the incidence release of the draft for public consulta- and prevalence of diet-related chronic tion, funding a ten-year implementation, disease risk factors and conditions among committing to a quality food and nutrition Australians, but it will also improve nutri- monitoring and surveillance system, and tion for the benefit of Australia’s health, reporting key targets to WHO and the FAO. Robert Hunt, DAA CEO wellbeing, sustainability and prosperity. “Updating the National Nutrition Policy “A new National Nutrition Policy would Striking an alarmist note, the DDA’s chief is imperative to ensure a co-ordinated and address the rising prevalence and health- executive Robert Hunt – no relation to the collaborative approach is undertaken to care costs of diet-related chronic disease, right-aligned federal health minister with improve food and nutrition-related health and help improve food and nutrition secu- the same surname – said, “There is no point and reduce the adverse outcomes due to rity, Aboriginal and Torres Strait Islander spending money on portfolios to service the poor diet in Australia,” it says. health, the nutritional needs of vulnerable population, because the reality is, if we con- Australians, sustainability, social equity “Specifically, a new National Nutri- tinue without a collaborative, contempo- and productivity. tion Policy would create positive change rary nutrition framework, we won’t have a by co-ordinating both government and population.” “It would take into account key food non-government strategies towards reduc- supply influences, such as agriculture, Or at least a healthy and sustainable one. ing the burden of diet-related disease, pro- environment and trade. A contemporary viding structures to systematically reduce Attending the report’s Feb 12th launch policy would integrate key current policy diet-related health inequalities, contrib- at Parliament House were the Heart Foun- tools and programs including: the Austra- uting to increased prosperity, securing an dation, Nutrition Australia, Public Health lian Dietary Guidelines (due for review), environmentally sustainable food and nu- Association, Diabetes Australia, Carers Nutrient Reference Values (under ongoing trition system [and] reflecting internation- Australia, Mental Health Australia, Nation- review), food labelling initiatives (including al and national best-practice activities, to al Rural Health Alliance, NDIS, Australian the Health Star Rating system), relevant keep Australia’s nutrition approach current Institute of Health and Welfare, CSIRO taxes and laws and monitoring and surveil- on the world stage.” and the Department of Health. More than lance systems.” 6,900 dietitians across Australia have con- Desirable goals that should be achievable The DAA is calling for the government tacted local MPs urging them to petition for if the political will and budgetary alloca- - presumably the next one - to rejuvenate a new National Nutrition Policy. tions are brought to bear. the National Nutrition Policy through

GPSpeak | 27 ‘Rural taster’ leads to career path by Jessica Holster 4th year medical student, UOW longong (UOW). A dream was becoming a reality right before my eyes. I did not come to study medicine because of any childhood dream or lifelong aspi- I accepted an offer to study medicine at rations to save lives, which is perhaps the UOW and began a journey of a lifetime. In more conventional path into this career. my first year I took up the opportunity to I finished high school in Port Macquarie undertake a voluntary clinical placement in in 2009 and went straight to university to Grafton Base Hospital. It was a two week study radiography. I graduated in 2012 and ‘Rural Taster’ for those who were interested commenced my career as a radiographer in in rural medicine. Coffs Harbour. I rotated through the different depart- It was during my time here that I began ments and medical teams within the hospi- my journey towards becoming a doctor. A tal, finding that I was quickly welcomed and radiologist at my work noticed that I was made to feel like a member of the team. The trying to further my education through doctors were encouraging and patient and various university courses, none of which took every opportunity to teach me. maintained my interest. He enthused me to It is such opportunities as these made sit GAMSAT. I battled with the thought of During my Rural Taster I met the chief radiographer in the hospital imaging de- possible by the University that reinforce the becoming a doctor for the simple fact that dream of becoming a rural doctor. I love I did not believe I could possibly be smart partment and was lucky enough to arrange some holiday work. I have returned to the strong sense of community you get to enough or as brilliant as some of the doctors experience every day and the unmatched I had the honour of working alongside of. Grafton Hospital every year since in my holidays to work within their department. This passion to teach in a safe, nonjudgmental With his encouragement and reassur- has allowed me to maintain my skills as a environment. Even though I do not know ance, I agreed to sit the exam and see what radiographer, form many new great friend- for certain where my journey will take me, came of it. In 2015, to my absolute shock ships, gain more exposure to a rural clinical I am hopeful that it will lead me to a place I passed GAMSAT and received an invita- setting and in a hospital full of friendly and I can feel as inspired and encouraged as I tion to interview at the University of Wol- supportive staff. have during my time in Grafton. Med students link with local medical workforce The staff, students and preceptors that form part of the Clarence Valley University of Wollongong (UoW) Phase 3 Extended Clinical program, celebrated the end of the year in a Christmas get together in November 2018 (picture right). UoW in collaboration with the North Coast University Centre for Rural Health ,has a strong focus on preparing medical students for rural practice has been sending students to the Clarence Valley since the establishment of this post graduate medical degree 10 years ago. Whilst on placement in the Clarence Valley, senior medical students spend time at Grafton and Maclean Hospitals and local General Prac- tices, as well as immersing themselves in the local community. As the Clarence Valley reaches the milestone of supporting these students for 10 consecutive years, it is time to reflect and celebrate. Pictured are medical students with preceptors from the Hospital and General With the Phase 3 program being so dynamic and diverse, involving Practice. (L-R) Medical student Jack Archer, GBH staff specialist Dr Kanewala many primary and community based health settings, it is rare that all Jayasekara , medical student Keiran Davis, medical student Felix Loschetter involved get together and connect. and GP Dr Nicholas Cooper.

Joanne Chad, Clarence Valley Regional Training Hub, Program Coordinator P 02 6641 8349 M 0438 265 938 Email - [email protected] Book ReviewBook Review - Eggshell Skull

Eggshell Skull The rest of the memoir switches to Lee’s Bri Lee personal history, ending with her sitting on the other side of the courtroom, watching Allen & Unwin the impassive face of another judge’s asso- Reviewed by Dr Zewlan Moor ciate. Along the way, she explores the com- Image provided by @byronbiblio plexities of dissociation involved in coping with trauma. In particular, she found it hard to simultaneously show her vulnerabilities, Statistics show that about 1-in-5 women but also present as a resilient fighter. And experience sexual assault (ABS - Personal this is where the title comes in: Safety Survey, 2012) yet only 1-in-6 reports to police of rape and less than 1-in-7 reports As the back cover blurb explains, ‘Egg- of incest or sexual penetration of a child shell Skull’ is a well-established legal doc- result in prosecution (Sexual Offences: Law trine that a defendant must ‘take their & Procedure Final Report, Victorian Law the way defence lawyers stage delay after victim as they find them’. But what if it also Reform Commission, 2004). delay in the hope of the prosecution giving works the other way? What if a defendant up. The process of jury selection is also on trial for sexual crimes has to accept his This book, shortlisted for the 2019 Vic- abominable, with most females and educat- ‘victim’ as she comes” a strong, determined torian Premier’s Literary Award and Indie ed prospects being sent home. It is definite- accuser who knows the legal system, who Book Awards, ly a case of “a jury of one’s peers”, if peers will not back down until justice is done?” tells a personal story behind those figures. means other men who think it’s fine to get a This book will help you empathise with It starts off as a journey into the working bit rough with women. victims of sexual assault and those indi- life of a young, idealistic law graduate who Out of all her case studies, there was one viduals who do not wanted to report sexual lands a prestigious job as a judge’s associ- happy story of a childhood sexual assault assault to the police. It will make you want ate and then does the rounds of the District perpetrator being found guilty - not sur- to fight for law reform. I am so happy that Courts in rural Queensland. prisingly, in that case the victim was a man. this brave, articulate woman wrote this It’s easy to be cynical when hearing about compelling page-turner. Just when you’re thinking the legal ridiculously short sentences for horrif- system can’t still be that bad you realise Prescribed for: Medical professionals ic crimes. What is intriguing is the actual this was all happening as recently as 2016… working at the coalface of sexual assault, machinations of the legal system, such as and still? e.g. GPs

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30 | GPSpeak OAM honour for local anaesthetist

North Coast anaesthetist, Chris his medical student days in The marriage Lowry, has been awarded the Sydney. He subsequently of his interests Order of Australia in the recent served with the Navy for in swimming, Australia Day Honours list. four years full time then diving and an- Dr Lowry is a former Director subsequently as a reservist. aesthetics has of Anaesthesia at Lismore Base After leaving the navy he made him an Hospital as well as a past Direc- trained as an anaesthetist. expert on un- tor of Clinical Training for Junior He was a VMO at Royal derwater medi- Medical Officers and a past Anaes- North Shore Hospital before cine. He is also thetics Training Supervisor. He coming to the North Coast in an author of has been heavily involved in train- 1992. the widely read ing LBH residents and registrars book, Diving Dr Lowry has worked with and Subaquatic Medicine. over many years and as testament Dr Chris Lowry overseas aid organisations to this work some of his former since the mid eighties. He has In semi retirement you will no longer students have returned to the area as con- made multiple trips to South East Asia and finding him in the theatres but is still doing sultant anaesthetists. the Pacific Islands as part of Interplast, the some preadmission assessment clinics. If Dr Lowry has a long standing interest organisation of Australian plastic surgeons you’re quick you might catch him some- in underwater medicine which he first that provides plastic and reconstructive where between The Pass and Main Beach developed when he joined the Navy in surgery to nations that lack these services. early on a Sunday morning. Dosage a key factor in medication adherence by Alanah Mann, pharmacist ed by the prescriber. The frequency can be daily, weekly, fortnightly or as otherwise The 6th Community Pharmacy Agreement requested. A prescriber only needs to an- (6CPA) provides funding for pharmacists notate their wishes on the prescription and to deliver professional services to eligible this will be followed by the pharmacist. patients. These services are provided at no This service can be used for any patient, cost to the patient and they aim to improve but may be particular useful patients with patient outcomes and medication adher- mental illness or drug dependency issues. ence, to increase communication with In most cases, the patient only needs to other health care professionals and reduce pay for the usual cost of their medication. medication misadventure. Medication Management Programs Whilst there are many components to the include Home Medicine Reviews (HMRs) 6CPA, the most relevant to prescribers are and MedsChecks/Diabetes MedsChecks. described below. Natalie Green (left), pharmacist and proprietor A HMR is completed in the patient’s home of Terry White Chemmart Alstonville, and Medication Adherence Programs include and is a comprehensive clinical review of pharmacist Alanah Mann. Dosage Administration Aids (DAAs) and a patient’s medicines performed by an ac- In addition, Diabetes MedsChecks focus Staged Supply. Dosage Administration credited pharmacist. Aids (DAAs) are often known as ‘Webster on the patient’s management of their dia- This service requires a written refer- Packs’. Whilst these are particularly useful betic condition, including their medica- ral from the GP and the patient is able to for patients with complex medication reg- tions and any blood glucose monitoring choose their accredited pharmacist. The ac- imens with multiple medications, such devices. The patient will be given a copy credited pharmacist will provide a written as quarter or half tablets or alternate day of their MedsCheck/Diabetes MedsCheck report to the prescriber along with any dosing, they are also beneficial in many which lists their medication, instructions recommendations to be discussed and re- other situations. for how to take, what the medication is viewed at their next GP visit. for, as well as any additional information For example, children using psychostim- deemed necessary. A copy of this can be MedsChecks/Diabetes MedsChecks ulant medication in school packs, or pa- sent to the prescriber as requested or con- include a review of the patient’s medi- tients with simple medication routines but sidered necessary. cations, with a focus on education and miss doses frequently as the DAA allows self-management. They are performed them to see if doses have been missed. A MedsChecks/Diabetes MedsChecks within the pharmacy by the pharmacist. can be initiated by the patient or their carer, DAAs are also helpful for travellers as MedsChecks/Diabetes MedsChecks aim the pharmacist or the prescriber. If you each medication is identifiable and the bulk to identify and assist with any issues that wish for your patient to receive this service of multiple boxes or bottles is reduced. If the patient may be experiencing, such as no formal paperwork is required but a you wish to start a patient on a DAA, please side effects, poor adherence or issues with medication summary is often useful. Issues send a medication summary along with any access to their medications. The service identified during the MedsCheck/Diabetes prescriptions needed to give to their phar- can also provide education on the patient’s MedsCheck process can be further explored macist. medication and associated medical condi- via a HMR if required, as a MedsCheck/ tions, as well as how to best use and store Diabetes MedsCheck does not preclude the Staged Supply allows for the provision of their medicines. HMR service from being performed. PBS medicines in instalments as request-

GPSpeak | 31