Spotlight on Youth Health

Inside: Pill testing urged GPs win awards Bonfire of the faxes

Spotlight on youth health

Quarterly magazine of Northern Rivers General Practice Network Summer 2016 - 2017 Cover photo courtesy of in this issue - Markus Ravik Email: markus@ markusravik.com.au Editorial 3

Chairman’s report for NRGPN 2016 4 Website : http://www. Pill testing vital to help save young lives 5 markusravik.com.au/ Lifestyle and distance hit cancer patients 6 ‘Second decade’ health care gets youth scrutiny 7 editorial team Byron Bay’s eVillage project wins health care award 8 Dr David Guest Chair NRGPN Lismore and Ballina MPs respond to pill testing 9 [email protected] New research into young people’s health experiences 11 Dr Andrew Binns Clinical Editor Young people and substance abuse – listen and learn 13 [email protected] BUDDIng up to keep Byron schoolies safe 15 Solving the Troubles of Derry / Londonderry 17 Robin Osborne Editor [email protected] Capture the Fracture 19 Family Support for ICE users 19 Angela Bettess graphic | web design GPs score well in Primary Health awards 21 [email protected] Local Health Issues - What’s Up? 22 Condom users too cocky about their skills 22 Former GP to lead University Centre 23 gpspeak on the web MyGP TV 25 www.gpspeak.org.au Group Programs for Anxiety Management for 2017 25 search All articles in GPSpeak can be found by searching Teaching professionalism to tomorrow’s doctors 27 the website. Click the articles’ links to directly access exhibitions hail end of an era 28 references and other resources mentioned in the the print edition. Art talent breaks out to the mainstream 29 subscribe GP Synergy 2016 Outline 31 Get the latest from GPSpeak by subscribing to the 1-in-4 say some medical interactions unnecessary 32 newsletter that comes out once or twice each month. Add your email address to the form in the right sidebar. Order in the House 33 write Red ribbon day for Lismore Base Hospital 33 Unless otherwise stated all articles in GPSpeak can be reshared under the Creative Commons Attribution- PRODA - Provider Digital Access 35 ShareAlike 3.0 Australia license. Managing Elderly ACF Patients - A Tidal Wave Building 36 GPSpeak welcomes contributions from members and the general public. Preparing for a ‘bonfire of the faxes’ 37 tweet The two faces of Bali 38 Follow @gpspeak and comment on #gpspeak. Book Review 39

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2 | GPSpeak Editorial

I’m on the drug, I’m on the drug. a crucial factor in most suicides. I’m on the drug that killed River Depression associated with relation- Phoenix. ship, work place or financial stresses I’m on the drug, I’m on the drug. accounted for nearly 20% of cases. I’m on the drug that killed River Earlier studies had shown that if Phoenix. suicide can be prevented at this critical time, most will go on to have David Caldicott (page 5), outlines the ratio- productive and full lives. I saw his body thrashing round. I nale for pill testing at music festivals. This is saw his pulse rate going down. This issue of GPSpeak looks at the risks a common practice in Europe and increases I saw him in convulsive throws. I facing young people during the rites of the number of successful emergency said “I’ll have one of those.” passage after finishing school and preparing room resuscitations by physicians like Dr … for tertiary study or entering the workforce. Caldicott. Now I’m bored and there’s no Surviving schoolies is the first hurdle and Pill testing is currently illegal in Australia stopping; I need another celeb to the crucial work done by the BUDDI team but emergency physicians have called for at fill a coffin; for Byron Bay schoolies is described on least a pilot. However, it is a matter of hot Where’ll I get my next drug page 15. action? Odds on it’ll be Michael political debate. On page 9 Tamara Scott, Jackson. On page 13 Lana Jankowiak of Lismore NSW State MP for Ballina, makes the case Headspace outlines the principles needed for changing NSW legislation and Thomas by TISM, 27 April 1995 to “cut through” to young adults and how George, NSW State MP for Lismore, argues they, like older adults, will use drugs or for maintaining the status quo. We thank them both for their contributions. The eighties Australian band, This is alcohol to reduce emotional stress. Serious Mum, was better known for its These principles are put into practice by Pill testing provides information on both biting satire than for its music. In retro- NSW Health’s Youth Health and Wellbeing the type of drugs that are prevalent in the spect, we can also acknowledge the lyrics Team (page 7). A recent workshop in community and their strengths. This infor- were terrifyingly prescient. Ballina attended by 41 young people mation is key for physicians resuscitating overdoses but can also be used by drug It’s not easy being a star. All that sex and concluded “They have a voice which needs takers to “optimise” their dose. Thomas drugs and rock and roll can take it out of to be heard. … Early intervention through George argues against the moral hazard of you. No young musician aspires to being supportive resources that reach all youth … providing this information to the drug using a member of the 27 Club (dead at the age will achieve better outcomes.” public. of 27). However the mere existence of the The music festival season is upon us. meme in popular culture highlights the risk Recreational drugs will be taken by fans For physicians the issue will come down for entertainers of all ages. and performers alike but are equally lethal, to whether we can successfully increase the number of people surviving their “drug A recent study reports there were just irrespective of your musical ability and experimenting youth” and go on to have over 400 drug related deaths in health accomplishments. The tragedy of deaths in long and fulfilling lives. care professionals in Australia between young concert goers haunts us each year. 2003 and 2013. Access to lethal drugs was Our feature article by Associate Professor A trial is indicated.

GPSpeak | 3 Chairman’s report for NRGPN 2016 by Dr David Guest

‘Tis the season for Christmas parties, and refinancing of GP Training that has website are the main focus of the Network’s commented my taxi driver recently, then come into effect this year. Doing more with activities, but we have also initiated two wondered “;end of year, end of school, less supposedly lifts your efficiency, if not small IT projects which are within its perhaps even end of days…” your mood, and is not much consolation. limited capacity to support.

Taxi drivers don’t have an end of year Increases in costs for continuing medical The Northern Rivers Medical celebration, he mused. They may work in education and practice accreditation (CME) Exchange (NRMX) facilitates data the same industry, largely know each other continue unabated and the principle of user exchange between surgeries, allied health but often they don’t get on: “It’s a business, pays is being expanded in novel ways by the practitioners and pharmacists on the North you know.” CME industry. Coast. Its goal is limited to rapid communication and it makes no attempt to be a A lot has happened in the four years since It seems likely that revalidation will be the common platform for a patient’s ongoing the Divisions and Networks of General next issue to confront Australian general care, which is an important component in Practice were defunded by the Federal practitioners. It is to be hoped we can chronic and complex disease management. government. Money is tight and primary escape the bureaucratic mess that British It will therefore dovetail with the North health care is feeling the effects. It is likely GPs face and that sense will prevail with Coast’s “Orion” health project to manage to get tighter in the future. Grand schemes efforts being directed to quality improve- such patients and is due to come online in are on hold or abandoned. There is a perva- ment activities both within general practice the latter half of next year. sive feeling of the need to buckle down and and the wider primary health care system. just get through to the next election; three The NRGPN has also worked in part- years at the grindstone! In the last few years the North Coast has nership with the local Health Promotion been the site for a number of successful Unit to disseminate public health messages GPSpeak is the voice of the Northern programs in this area, jointly sponsored by and announcements through GP surgery Rivers General Practice Network (NRGPN). the North Coast Primary Health Network televisions. Advances in communication It is an independent voice aiming to chroni- and the Northern NSW Local Health technologies give individual practices the cle the health issues on the North Coast and District. opportunity for greater control over the advocate for solutions to those problems. Our area is not part of the Federal govern- messages they display to their patients than The Federal government’s December ment’s Medical Home trials and it would be those provided by commercial interests. 2015 Mid-Year Economic Fiscal Outlook disappointing if the expertise in integrated During the financial year to July 2016 (MYEFO) statement took the profession by care built up by these two organisations is the Network lost just under $15,000 as surprise. It foreshadowed a further series lost. Thankfully there are moves afoot to shown in our Financial Statements. While of defundings in the health portfolio, with explore the Medical Home model of care disappointing this represents a $5,000 a proposed abolition of bulk billing incen- outside of the Federal trials. improvement on the previous year. tives for pathology and radiology. Drug, alcohol and lifestyle problems Pleasingly two thirds of that loss related to After an outcry this turned out to be too along with mental health care have been a decrease in the value of the investment politically unpalatable for the government a frequent focus for GPSpeak this year. portfolio, which should recover. The loss and was swapped for a legally dubious Progress in these areas is always slow and from operating activities was under $5,000. cap on rents for space in general practice difficult but the potential gains are large. This augurs well for the future sustainabil- surgeries by pathology companies. We will continue to report on and advocate ity of the Network. in these areas. The MYEFO, however, was soon followed In recent months the Board has debated by the May Federal budget and then the The uptake of the My Health Record whether its current activities in general prac- July Federal election. Once again health (MHR) system has seen significant tice advocacy, media and communication was a target, with an extension of the freeze advances in the last six months follow- should remain its core focus. Addressing on Medicare rebates for four more years. ing the acknowledgement, finally, by the local clinical issues was the raison d’être of Department that general practice needed the initial Divisions of General Practice and The profession was gob smacked. Even to be properly financed to make the system it was by making a difference locally that the Feds agree that investment in primary work. While a step in the right direction, the general practitioners became enthusiastic care is likely to pay dividends down the failure of the MHR to support the download about the organisation. track. General practice is an easy target, and population of the GPs’ electronic health however, and Treasury just told the The next NRGPN Board will have to records is a serious cap on the system’s util- address its representation, relevance and Minister for Health to take the money and ity. There appears to be no suggestion that run. engagement with its members. As my taxi the Department is intending to address driver noted, it is a difficult task. GPSpeak has chronicled the dismay many this. in our area have felt with the reorganising GPSpeak magazine, newsletter and

4 | GPSpeak Pill testing vital to help save young lives

by Assoc Prof David Caldicott between the licit and the illicit, for current ‘flakka’ or ‘gravel’. These ‘moral panics’ do global categorisations are far more to do little to inform the public about the real After an unseasonably cold and wet with tradition, international lobbying and story, which is far more disconcerting. For winter, we are beginning to see the sun in political influence than they are to do with nerdy spectators such as myself, ‘flakka’ (or Canberra. For many, this marks the time health. alpha-pyrrolidinovalerophenone, a cathi- to dust off the BBQ, clean the pool, or after none derivative), is old news. We provided the Melbourne Cup, put down this season’s the AFP with a detailed assessment of it crop of tomatoes. neary two years ago, which in the modern For those of us involved in the acute market is a geological period of time. management of medical presentations The real story is the evolution of the associated with recreational drug overdose, market itself. Gone are the days when we also have other things on our mind. And smugglers only moved large quantities of a for the Antipodean 2016/17 Season, like relatively small number of different prod- medically qualified meerkats, we are very ucts, in the knowledge that while some nervously eyeing up the dark clouds rapidly might be seized, most would get through. gathering on the horizon. Multimillion dollar drug busts, while There will be those of you who take sounding impressive, are usually inflated in exception to the phrase ‘recreational drugs’. value, and represent irrelevant quantities I get that. Many of you will have never used as far as the overall market is concerned (if any illicit product in your lives; some of you they were significant, one would anticipate might even be teetotal, or non-smokers. I downstream changes in price points, which congratulate you on your abstemious ways. never occur). The market has evolved to But the values assumed by our very avoid even this ineffective form of inter- conservative profession are not the same diction. Young Millennials conduct their as those of as many as 25% of your fellow Associate Professor David Caldicott research on line, internationally, behind the citizens. secrecy of the Dark Web. They share experi- If a substance called ‘alcohol’ emerged ences, and pay for drugs using untraceable Those rendered indignant about acknowl- on a modern market, it would rapidly earn cryptocurrencies. Drugs, manufactured edging the fact that young people use drugs its position on Schedule 9, well ahead of to pharmaceutical purity, are delivered for pleasure rarely end up being the same cannabis in terms of global harms caused in small packages, by the postie. Many of people that influence their behaviour. We to Australians. That these same laws place them are undetectable in either basic urine have talked to thousands of drug users at cannabis and methamphetamine in the screens, or by sniffer dogs, making them Australian and European music festivals, same category of harm is a historical anach- very attractive to those in occupations such and hundreds of patients in emergency ronism, which, coupled to the kind of facile as mining and long-haulage, as well as festi- departments, on both sides of the equator. ‘just say no’ message promulgated by those val goers. And it is simply naïve to assume that the as medically qualified as Nancy Reagan, 21st century consumer seeks drugs for any The drugs themselves are like mayflies has achieved one thing - a generation that reason other than ‘pleasure’ or ‘recreation’. - with incredibly brief commercial lives, doesn’t believe anything that it’s told about partly in response to woefully inadequate Avoiding the term is as about as effective drugs, except from its peers. attempts at sweeping interdiction, and an exercise in social marketing and public So instead of a morality approach to drug partly due to the apparently insatiable health as trying to re-brand ‘king hits’ as use, we speak to the harms that any drug, appetite of consumers for something ‘new’. ‘coward punches’. legal or not, can cause, particularly with In the early 00s, I remember being Once we get over this strange philosoph- immoderate use. worried by less than 20 illicit drugs - I had ical hurdle, we can then move to what we We try to be as non-judgemental as possi- their structures on a T-shirt! At a meet- are good at, to what we ‘own’ - talking to ble. When users or patients understand ing of the UNODC Committee on Novel consumers about the known ‘costs’ associ- that we are keen to keep them alive, rather Psychotropic Substances in Vienna in ated with the perceived ‘benefits’ of drug than put them in prison, they are happily October 2016, we were advised that the consumption. forthcoming about their use. number had now exceeded 700. There is no way that our traditional models of interdic- I am, of course, referring to the substantial In the last year, there has been a huge tion can cope with this burden - their rate of and potentially devastating health ‘harms’ media focus on individual drugs, such as evolution is proof of this. associated with any drug consumption. ‘ice’ or more recently, an apparently noto- I don’t pay much heed to the differences cont p6 rious, zombie-creating entity known as

GPSpeak | 5 Pill testing (cont from p5) So much of our effort - and expenditure - summer, often overwhelming emergency in Australia is spent on seeking , but failing, departments with ventilation require- to prevent drugs coming into the country. It ments. Naloxone was required at 10-20mg amounts to billions of dollars. But what if doses, with subsequent infusions. we were to try something new? What if we THE AUSTRALIAN DRUG OBSERVATORY were brave enough to focus our efforts on In Europe, colleagues conducting drug checking at music festivals, a process now reducing the demand side of the equation? information about emerging products on in its second decade in the EU, have iden- the market, long before customs or police One country that has made the move with tified ecstasy pills containing over 200mg seizures. Far from encouraging drug remarkable results is Portugal. Back in the MDMA. When one considers that 75mg is consumption, it moderates it, making early 2000s, then-prime minister António what most will need to get them where they life-threatening overdose far less likely. Guterres effectively reversed the funding want to be - and it is not unusual for young imbalance between law enforcement and Australians to ‘double-‘ or ‘triple-drop’ - it I have my own kids now. I would love to health, pouring resources into the latter. is not hard to get twitchy about the pros- be able to give them the real fairies and the pect of these agents reaching Australian unicorns that they so desperately crave for The result was a dramatic improvement music festivals, including those on the NSW their birthdays. At present, there is more in nearly every measurable health metric North Coast. chance of that than there ever being a drug- pertaining to drug use. (Guterres is due free Australia. to become the next UN Secretary General, On the subject of pill-testing, there are with every expectation that he might have now no academics of repute left in the AOD What we can do is to commit to trying something to say about international drug sector in Australia who don’t believe that at anything that we can to stop another death, policy). least a pilot should be conducted here. another sacrifice on an altar of a false ideol- ogy. It may not appear palatable to those Back in Australia we can learn from our The opposition is entirely political, relying on popularity contests for their colleagues’ experiences in the summer largely because to accept such a pilot careers, but that does not include the medi- months of the Northern Hemisphere where might be construed as sending ‘The Wrong cal profession. at least two worrying trends have emerged. Message’, this apparently being that it is entirely acceptable for young people to There will never be a drug free Australia, The first has been the identification of die in the service of teaching a lesson to and not one life is worth trying to make it ultra-potent fentanyl analogues in the illicit other consumers about the dangers of drug that way. market. Some of you will recall the infa- consumption. mous ending of the Moscow Theatre siege Assoc Prof David Caldicott is a Consultant in 2002, when Russia’s FSB gassed both No physician can support the barbarity of Emergency Physician, Emergency Department, patrons and Chechen terrorists alike to end that approach. Calvary Hospital, Clinical Senior Lecturer, Emergency Medicine, Australian National the siege. One of the substances involved What we know about pill testing is that University (ANU), Assoc Prof, Health & Design, was carfentanil, active in humans at the University of Canberra, and Clinical Lead, weight of a snowflake. North America expe- it alters consumer behaviour - at the point Australian Drug Observatory, ANU. rienced numerous multiple overdoses this of consumption - while giving us invaluable

Lifestyle and distance hit cancer patients

Lifestyle behaviours and distance from a were found to have the worst cancer survival agricultural work. metropolis are the major factors contrib- rates, the nation’s cancer ‘hot spots’ are the uting to regional Australians contracting inner regional areas - including the NSW “Additionally, rural areas of Australia cancer at higher rates than city dwellers, North Coast. These have the highest inci- witness a higher prevalence of cancer risk and being more likely to die within five dence rate in six of the selected cancers: factors such as smoking, alcohol consump- years of diagnosis. prostate, breast, colorectal, melanoma tion and obesity,” it adds. of the skin, non-Hodgkin lymphoma and “Having multiple risk factors increases These are key findings in the Garvan kidney cancer. Research Foundation’s new rural health the likelihood of developing a chronic report ‘A Rural Perspective: Cancer The main reasons, says the report, relate condition.” and Medical Research’ . to environment and lifestyle risks - for All up, one in two Australian men, and instance a high rate of melanoma among While remote and very remote dwellers rural people who engage in outdoor and cont on p14

6 | GPSpeak ‘Second decade’ health care gets youth scrutiny

After a plea not to On Diversity and be distracted by the Youth Participation, view over Ballina’s a wide range of issues Lighthouse Beach, 41 were raised, includ- young people from ing the grief and the Northern Rivers sorrow Indigenous convened in late youth often carry September to share from their elders, their opinions about a lack of adult role local health care with models, transgender representatives of the issues, the need for NSW Health Ministry. better mental health support, and commu- Participants were nication problems. asked not to pull punches when discussing five The Health key topics - Health and Promotion and Health Issues, Access Online Services/ to Services, Service Resources session

Providers, Diversity and At the Youth Health Consultation at Ballina Surf Club, young people discuss the health issues that most concern them. discussed social Youth Participation and media, making Health Promotion and Online Services/ Preference was expressed for seeing the health promotion campaigns more effec- Resources. same health professional whom they can tive, involving young people in youth health build relationships with, while many felt planning, and using youth advocates and On hand to assist the process were two seeing a doctor of the same gender is a spokespeople. senior officers from the Ministry’s Youth more comfortable option. Health & Wellbeing Team, Dr Sally Gibson A closing statement endorsed by partici- and Dr Carmen Jarrett, with other adults The meeting made a recommenda- pants said “many felt pleasantly surprised assisting as facilitators and scribes. tion for health professionals to develop by the format of the day, and this type of succinct bio-data, perhaps via an app, to forum was invaluable and an ideal situation Four key themes emerged from the topic, provide information about youth friendli- because young people shared experiences Health and Health Issues: Being Healthy, ness, specialisations, and attitudes about and engaged and interacted in a group Social Connection, Mental Health and cultural, spiritual, sexual and personal through discussion.” Drugs and Alcohol. Discussion included situations. a general feeling of stigma against youth, “Up to 20 per cent of young people has i.e. all youth are lazy, a need for one or more chronic condi- sexual health education, and tions (excluding mental health too much time spent in front issues), and two per cent has a of computer/phone screens, disability…” including cyber bullying. The day was aimed at getting Access to Services gener- direct input from a regional ated discussion around sampling of the state’s 1.26 transport problems, confidenti- million young people about the ality, stigma, choice, information easy of accessing care and advice access, support and affordability, from GPs, community health and the broad issue of rurality. and hospitals, and what providers might be able to learn from Service Providers drew hearing their views. comments about health professionals, mostly positive, with It was one of two held in NSW, an emphasis on the need for the first in Parramatta a week doctors to be open and not judg- earlier when 120 urban partic- mental, use simple language and ipants discussed what aspects explain things, and allow young of health care they felt were people to make decisions. working and which might be Pocket information cards on Medicare and patient privacy for young people, produced by NSW Health. cont p8

GPSpeak | 7 Byron Bay’s eVillage project wins health care award

An innovative technology The weekly ‘virtual clinic’ partnership between Byron has been operating for 18 Bay GP practice Bay Medical months, and is playing a key and Feros Care Village has role in Feros’s philosophy of received high recognition providing a positive transi- in the North Coast Primary tion to residential aged care Health Care Excellence - making pets welcome is Awards. another facet.

The awards, run by The use of videoconfer- the North Coast Primary encing has resulted in this Health Network (NCPHN), project receiving an award were announced in Coffs in both the inaugural North Harbour on 9 September. Coast Primary Health Care The inaugural event was a Excellence Awards and in Residents of Feros Care Village no longer have to leave home to speak to their GPs, nor do doctors need to attend the national first for one of the facility for every consultation the 2016 HESTIA Aged Care Commonwealth-backed awards. Primary Health Networks responsible for their medical care and NCPHN’s Chief Executive Dr Vahid and focused on showcasing the work of GPs, Feros staff to address the needs of residents Saberi said the project is another example allied health practitioners and community with complex conditions. of how innovative thinking by clinicians health workers throughout the Tweed to and their health care partners is improving Port Macquarie region. Over a two-year trial period, Bay Medical conducted more than 400 video calls with the health and wellbeing of North Coast The project, known as the eVillage, was Feros Care Village Byron Bay. The project residents, whether in urban centres or the honoured in the Promoting Healthy Living involved four GPs and 48 seniors. rural hinterland. category of the awards. It has established “The Awards are designed to publicly a fast and dependable connection between It was found to help avoid 52 hospi- recognise those making a real difference to aged care residents and their GPs through tal admissions, with more timely care the community’s wellbeing by honouring videoconferencing. advice provided in after-hours situations. Transport costs for seniors were reduced by their efforts and the proven outcomes of Face-to-face contact using iPads $40,000. their work,” he added. or computers enables residents, GPs Links to contact details for all entries.

‘Second decade’ health care cont from p7 improved. young people have about bulk billing - they The organisers said the forum’s key are entitled to their own Medicare card message was that youth have specific health Young people are defined as being in the from the age of 15 - and privacy require- needs and often face barriers and are placed 12 to 24 years bracket, the so-called ‘second ments by health care providers. Pocket in vulnerable situations when using health decade’ of life that WHO and other bodies reference cards are now available on both services. see as crucial to improving the health of the topics. overall community. “They have a voice which needs to be The NSW Youth Health Policy 2011-2016 heard. Youth want to see more youth friendly While statistics show that 86 per cent of is in the process of being updated via this services and be encouraged to have better this cohort in Australia believes themselves consultation process, guided by a discus- health outcomes through positive rela- to be well, up to 20 per cent has one or more sion paper, Towards the Next Youth tionships with health professionals... Early chronic conditions (excluding mental health Health Policy intervention through supportive resources issues), and two per cent has a disability. that reach all youth, such as education and An emergent theme from the Ballina and Clearly more work needs to be done in the mentoring, will help achieve confidence Parramatta sessions has been the need for and provide better health outcomes.” area of mental health, given the unaccept- clinicians to listen more carefully and less ably high youth suicide rates, and emotional judgmentally to their youthful patients/ The event was supported by the Northern wellbeing was a commonly raised issue in clients, and help them to acquire knowledge NSW Local Health District, the North Coast the forum. that will enable better informed decisions Primary Health Network, Social Other matters were the uncertainty some about their health care. Futures, Headspace, and North Coast TAFE.

8 | GPSpeak Lismore and Ballina MPs respond to pill testing

Tamara Smith (Greens), State MP for The State MP for Lismore, Thomas Ballina (which includes Byron Bay), George (Nationals) responds to pill comments on pill testing: testing at youth oriented events:

“I support pill/ “Party drugs drug testing are too great at music a risk” festivals…”

Pill testing is controversial a risk taker gets a ‘chance’ to There have been a number of should be opposed is the fact in Australia because of the manage that risk with greater calls suggesting pill testing at all it can tell you is some- misconception that laws knowledge of the substance public events is the answer thing about that particular prevent people from imbib- they are taking. to the deaths and injuries pill. We know that bikies ing and a lack of awareness resulting from consumption and others who make these around addiction. Drug If pill testing makes a risk of illicit drugs. drugs put distinctive logos users make a personal choice taker think about what they on them … but that is no to risk their health and the are ingesting, isn’t this just This is not an approach the guarantee pills that look health of those around them one small but positive step Government can support. alike actually have the same when they take drugs. With towards educating our youth chemical composition. on their choices? The Greens Rather…we want young the status quo and illegal- people to understand that ity of drug testing at places NSW MLC and Drugs & Harm This is a critical flaw in Minimisation spokesperson every pill they take at a proposals to test pills at like festivals, drug takers dance party…music festi- have an unforeseeable risk Dr Mehreen Faruqi is a crucial dance parties and music advocate for our State on this val or other such event is a festivals. of further harm because potential risk. they do not know the exact matter, and I will be working with her closely for this region. Pill testing may also be substance they are imbibing. Pill testing can only viewed as providing tacit provide false confidence that I support pill/drug testing The Greens’ door is still open approval of the taking of to the Premier to discuss pill what someone’s intending to so-called party drugs – or at music festivals in order take will not harm them. to help protect young (and testing at music festivals and even that the Government not-so-young) risk takers. bring him up to speed on the Assuring a drug user their is guaranteeing their quality This is a different matter events of the Parliamentary pills are ‘pure’ ignores a range and safety. from the moral issue of Drug Summit. A summit at of factors…including what which not a single represen- Pill testing will not be drugs, it is a safety issue. medicines someone might permitted on any property Collectively, turning a blind tative of the NSW Liberals take…their own physiology, and Nationals attended. If our where a government author- eye to the harm caused by including possible allergies, ity is the land-owner. dangerous chemicals in communities and leaders are how the pills could interact recreational drugs is forc- ignoring the issue, what exam- with alcohol or other drugs We want young people to ing drug takers to take risks, ple is this sending to those that the person has consumed… have a great time at dance rather than arming them look to us for guidance? and the possible effects of parties and music festivals… with choice. I hope that there will be more heat and dehydration. and we want everyone to head home alive and well. By adding a step to the open mindedness on this issue Another reason pill testing for safety’s sake. Party drugs are just too process through pill testing, great a risk.

GPSpeak | 9 10 | GPSpeak New research into young people’s health experiences

by Dr Carmen Jarrett • homeless or at risk of homelessness We know a lot about young people and • refugees or vulnerable migrants their access to health services, includ- • identifying as gender or sexuality diverse ing access to primary care. We know that The research study includes an young people do not always know where to online survey of young people in NSW, go to get help, or know about their right to complemented by a more in-depth longitu- confidential healthcare, and that they are dinal study of a sub-sample of marginalised less likely to have the money to pay for a young people and their journeys through visit to a General Practitioner who does not the health system over twelve months. bulk bill. The impact of digital media on access and We know that young people are frequent navigation will also be explored in both Dr Sally Gibson (left) and Dr Carmen Jarrett from the NSW Health studies. The perspectives of service provid- users of hospital emergency departments. Ministry’s Youth Health & Wellbeing Team. We also know that young people will look ers on access, health system navigation and often benefit from taking time to consider online for information about health and system inefficiencies will also be sought. the needs of young people and seek the health services, and we need to keep pace input of young people to make sure that Dr Melissa Kang, a GP and academic with the emerging uses of technologies to their service is welcoming for young people. with a long term interest in young people’s inform and provide healthcare for young health, is leading the study. people. NSW Health recognises that adolescence and young adulthood is a unique “We know that in recent years, lots of The need to provide healthcare with the life stage that requires a specific response young people are using the internet to get needs of young people in mind is now well from health services, and is in the process information about health, but we don’t recognised (see the recent series of articles of updating the NSW Youth Health Policy. have a good idea about how they use it to in The Lancet 383 (9915) 2014, the recogni- This will guide how NSW Health services decide when to go to a doctor or a health tion of adolescents and young adults as an and partner agencies (including primary service. We’d like to understand the things area of specialisation in medicine, and the care services) can best work to promote the that make it easy and difficult for young WHO report Health for the world’s adoles- health of young people. people to get the health care they need, and cents: a second chance in the second how technology fits in with getting help. decade ). In order to inform the development of the If young people see the internet as a great new Youth Health Policy for NSW Health The need to consider adolescents as a tool, then we need to let health services services, the Youth Health and Wellbeing particular group rests on three key ideas: know what more they can do to engage team in NSW Health has commissioned first, that the diseases that start in middle young people,” Dr Kang said. research - called the ACCESS 3 research age, such as cardiovascular disease and study - to gather information on how young The aim of the study is to understand how cancer, have their roots in lifestyle factors people access and navigate health services, young people make decisions about when that start or are consolidated in adoles- including how technology is influencing and how they choose health services and cence, second that optimising the health service use. The research is investigating what their experiences are like. The study of adolescents lays the foundation for a the experiences of young people across hopes to improve young people’s access to healthy next generation, and third that NSW and is particularly seeking to describe the health care they need. injuries and illnesses that can be prevented the experiences of marginalised young in adolescence provide a good return on Research findings will be presented to people. The ACCESS study is led by The healthcare investment over a lifetime. key stakeholders from policy and practice University of Sydney’s Department of to help translate the findings into poli- General Practice, Westmead and involves a The Northern Rivers area has a strong cy-relevant recommendations. tradition of helping GPs to be ‘youth number of investigators from across NSW. friendly’ – that is, making health care The online survey is open to all young The ACCESS 3 research study will understandable and accessible for young people aged 12 to 24 in NSW and can be describe the experiences of young people people. For young people, accessibility completed anonymously. Young people can accessing and navigating the health system means more than just physical access - ask for help from their parents if needed. in NSW, focusing on the barriers and it means feeling that the health service facilitators to accessing health care for welcomes young people, and that the The online study. information about the marginalised young people in NSW. The service is affordable for them. ACCESS study and youth health resource ACCESS 3 study will focus on young people links are available on the website. While some services such as headspace aged 12-24 living in NSW who are: *Dr Carmen Jarrett works with the NSW are specifically for young people, most • Aboriginal and/or Torres Strait Islander Health Ministry’s Youth Health & Wellbeing health services, including general practices, • living in rural/remote areas Team. are for a wide range of ages. These services

GPSpeak | 11

Coastal Vascular Group is proud to be a sponsor of GPSpeak, supporting GPs in Northern NSW. As one of the largest regional vascular practices in Australia, we are committed to providing a comprehensive world class service to the people of the Northern Rivers and surrounds. Our main office location is at St Vincent’s Hospital, Lismore and we provide an outreach service at numerous locations. Our practice specialises in the latest minimally invasive treatments for arterial and venous disorders.

CONSULTING LOCATIONS: Lismore – Level 2 Suite 4, St Vincent’s Specialist Medical Centre, 20 Dalley Street Ballina – John Flynn Specialist Suites, 79 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 Tugun – Suite 2B, John Flynn Medical Centre, 42 Inland Drive

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

OUR TEAM

Lisa Malena Dr Dominic Dr Anthony Kim Joy Kerry Secretary Practice Simring Leslie Practice Secretary Practice Nurse Nurse Manager

12 | GPSpeak Young people and substance abuse – listen and learn

Lana Jankowiak, Regional Manager, Headspace Lismore & Tweed Heads, highlights the importance of working collaboratively and having a holistic view of a young person and their multiple interrelated needs.

As professionals working alongside young and strengths. people, I believe we are obliged to be aware • Ensure that any intervention is youth and acknowledge the ‘UN Convention driven, focussed on the young person’s on the Rights of a Child’ and apply youth needs, rather than theoretically driven. centred practices when working with young Interventions need to be eclectic and take people. account the developmental level of the Loxley, Toumbourou and Stockwell (2004) young person. These include: has informed us that substance-using • Consider that what is seen as a positive behaviour of all young people develops over • Understanding the factors that influence outcome for professionals, parents, family time and is subject to a complex interplay young people’s lives does not necessarily imply a positive of bio-psycho-social processes. Paglia and • Being aware of young people’s rights and outcome for the young person. Room (1998) identify that, for adolescents responsibilities • Be mindful of the ‘language’ we use from in the process of developing their own iden- • Respecting young people’s identities, the onset, which can ‘exclude’ participation tity, AOD use might have several functions culture and diversity by young people including: providing pleasure; alleviating boredom; satisfying curiosity; facilitating • Consider how to break the stigma of • Understanding the developmental issues social bonding; attaining peer status; or as that young people face asking for help. As adults we need to role- model asking for help, accessing services an escape or coping mechanism. Equally, • Remaining curious about young people’s ourselves substance use could be a form of rebellion experiences or sensation seeking that has a symbolic Some questions we need to ask : function such as “…expressing solidarity in • Using creative and innovative a group and marking off social boundaries” approaches in dealing with issues young • How will we explain our policies/ assessment/interventions/plans/services people face. Young people who come to rely on to them – will we use youth friendly substance use as a coping mechanism or • Being genuine and honest in our deal- language? ings with young people form of escape are those most likely to • How do we consult with them, seek come to the attention of services. Young • Understanding our role and being clear feedback and ensure we are accountable to people tend to use substances as a coping about the role of the agency within which them? strategy in response to life stressors or we work. • How do we consult with and facilitate underlying problems that they believe are • Creating an environment that is young people to participate in contributing insurmountable or irresolvable. youth-friendly. to their treatment and how it may affect them? Substance use problems are often mani- • Challenging our own values and beliefs festations of unresolved, underlying issues about young people • We need to consider childhood and that have a cumulative effect in the life of adolescence as a place not a process – it is • Challenging our own values and beliefs each young person. In turn, substance-us- not a transition phase on the way to some- about substance abuse ing behaviour can add complexity to those place else – it is their everyday reality. underlying issues. • Considering what ‘need’ is being met by A great resource that has crossed my the young person by using a substance. Some young people use substances in path is Youth Drugs and Alcohol Advice an effort to reduce the resultant emotional We need to: (www.yodaa.org.au) It includes a ‘Toolbox’ distress, commonly referred to as self-med- which takes the vast range of evidence and • Invest time to understand factors that ication. The efficacy of substance use as a literature that supports Youth Alcohol and may influence substance use behaviour. coping strategy is confined to the present, Other Drugs (AOD) work, and presents it Young people are consumers but often because it tends to undermine the efforts of for practitioners assisting young people do not have a voice and/or are reliant on young people to deal with underlying prob- adults. to develop resilience and achieve their lems or stressors over the longer term. goals. An extract includes the ‘Function of • Ensure that assessment places partic- Substance Abuse’ ular emphasis on the young person’s The United Nations (UN, 2004) reported that the substance use of this group tends to perception and expression of his/her needs Research (Spooner and colleagues 2001: (continued p14) GPSpeak | 13 Listen and learn (cont from p13) Rural lifestyle and cancer patients (cont from p6) be about relieving the pressures of life, deriv- one in three women will develop cancer Australians can claim their share of the ing from difficult circumstances. Munford & before the age of 85 years. benefit.” Sanders, (2008) corroborate these findings and demonstrate that problematic substance The report was launched at the An important aspect of the report was use for young people is linked with chronic National Farmers’ Federation 2016 considering the role medical research can stress, alienation and a marginalised social National Congress in Canberra on 26 play in the health of all Australians. network. October. The Foundation says it “firmly places the spotlight on one of the “Medical research is critical in order to The Victorian Youth Alcohol and Drug federal government’s National Health address the shortfalls in our knowledge Outreach Guidelines (Pretroulias, Bruun, Priority Areas, cancer.” and improve outcomes particularly for Papadontas & Roy, 2006) identify several rural patients,” Mr Giles said. The report examines rural Australia’s personal issues that may turn a young person The Garvan Institute of Medical towards substance use for solutions. These cancer incidence and mortality rates, concluding that improvements being Research is a multi-disciplinary facil- include, but are not limited to: “…significant ity with more than 600 scientists and loss and complicated grief reactions; isolation experienced in major cities are not being seen in the rural context. PhD students working across six major and loneliness; adoption and family break- research areas: down; depression and anxiety; problems with Another key factor is the lower pres- anger; past or ongoing sexual assault and • Cancer – breast, colorectal (bowel), ence of oncologists, specialists and lung, ovarian, pancreatic and prostate; physical violence; and the effects of trauma associated health providers in regional/ such as post traumatic stress disorder” rural areas. • Diabetes and obesity – Type 2 diabetes, obesity and metabolic disorders; These issues also contribute to the uptake Calling the urban and rural health and continuation of behaviours such as • Immunology – asthma, rheumatoid gap “unacceptable”, Garvan Research arthritis, MS and Type 1 diabetes; offending, truancy and self-injury and are Foundation CEO Andrew Giles said, • Neuroscience – Alzheimer’s and factors that contribute to suicide risk for some “If we don’t act now, it will continue clients. To this list of issues can be added Parkinson’s disease, anorexia, hearing to grow. The ongoing challenge is to loss; poor physical health and less prevalent mental ensure that innovation in medicine is health concerns such as psychosis equalled by innovative policies that • Osteoporosis and bone disorders and bipolar disorder. increase access to discovery so that all • Genomics and epigenetics.

14 | GPSpeak BUDDIng up to keep Byron schoolies safe

Google search ‘BUDDI’ and the main Q: How many staff and volun- hits relate to personal finance programs. teers do you have, and what Add ‘Byron Bay’ and you’ll learn that it’s measures are put in place? What the acronym for the Byron Underage are ‘typical’ adverse events, and Drinking & Drug Initiative, a Community what are the main inquiries your Drug Action Team (CDAT) formed under team gets? NSW Health Community Drug Strategies Program and auspiced by Byron Youth A: We have around 100 local volun- Service. teers working in the HUB each year, and are joined by two teams of ‘Red Frogs’, Its aim is to provide and support drug around 150 in total, across the two weeks. and alcohol free youth events, educa- Our most adverse events, would be deal- tion and training for young people, their ing with first aid and in particular, high parents and those who work with youth. levels of intoxication.

The volunteer network for youth and We go through thousands of band aids community events recently became an each year, and many v-bags (vomit), it’s award winner, being honoured in early not just about alcohol or drugs, it can also November 2016 - as the annual ‘schoolies’ be about too much sun. The evenings can influx was looming - with the inaugural be very big for us, with up to 4000 young Community Drug Action Team NSW people in the park with us each night. State Influence Award for excellence, awarded by the NSW Ministry of Health We have had a few drug scares over the Nicqui Yazdi with BUDDI’s NSW State Influence Award for its Byron Schoolies and the Alcohol & Drug Foundation. Safety Response and Schoolies HUB initiatives years, mainly from herbal highs though, however, each year we are on the alert for Soon after accepting the award, Team reversed schoolies-related incidents, which anything that may be getting around and Leader Nicqui Yazdi was interviewed are essentially now negligible, with almost we find that even the schoolies are help- by GP Speak’s editor Robin Osborne. zero schoolies-related incidences for the ful in telling us if there are people dealing last three years. Q: This summer, around 10,000 drugs, where they are and we are able to then pass this information onto the police. young people will arrive for schoo- In fact over the last three years, all areas However the primary drug of choice by the lies in the Bay. What are your main of alcohol-related crime in Byron have schoolies is alcohol, and for many, it will be concerns, and what measures are reduced by 50%, so something is working! being planned to minimise the the first time they become seriously drunk. harms they might be exposed to? “Our local youth see these unrealistic images of partying A: Our main concern is that Byron Bay is a small town and having this many tourists, all year round, and this has become what they now young people descend for what is essen- see as the ‘cultural norm’ for themselves too...” tially their first holiday away from family Q: Recent stats suggest young and friends, means that stuff can go Our local Liquor Accord are very proac- people are less inclined to misuse down, both for these young visitors and tive and they have supported the Schoolies substances, legal and not, than in also the town as a whole. HUB initiatives ever since we first started, the recent past. Is this what you’re both financially, but also with having intro- So, the actions of the Byron Schoolies seeing, and why do you think this duced many voluntary measures that assist HUB assist not only the schoolies, but might be so? to make Byron a safer place at this time. also the town, in keeping them safe, A: Although this might be true on a informed and giving them activities, You can’t buy shots or jugs in Byron national level, Byron Bay has never really around the clock. We started this initia- establishments, nor can you buy alcohol/ fallen within any state or national ‘averages’ tive back in 2009, when crime in Byron energy drink mixes in the bottle-shops - or for any form of statistics. and in particular youth crime, actually large wine casks, just for starters. They also peaked in late November. produced packing tape and bags carrying Byron is essentially a tourism destination the ‘secondary supply’ information, which I learned quite by accident that we and as such, we do see extremely high levels helps to give the information that supplying had schoolies coming, I don’t think that of both alcohol and drug use, but alcohol is alcohol to minors is illegal. These initiatives the town really knew this, so we started by far the substance of most concern. We were introduced in consultation with the the Schoolies HUB. Since then, we have BUDDI Community Drug Action Team. managed to reduce crime and completely (continued p16)

GPSpeak | 15 Byron schoolies safe (continued from p 15) don’t see a lot of drugs among the schoo- Q: What role might GPs and other Q: On drugs... you believe these lies, it is mostly alcohol. health care professionals be able to should be treated as a health issue play in terms of keeping our young rather than a law and order one. But for our local youth, they see these people safer? What harm minimisation measures unrealistic images of partying tourists, all might be implemented to keep young year round, and this has become what they A: I think that GPs can be of great assis- people safer? now see as the ‘cultural norm’ for them- tance in reminding young people that they selves too. are safe to talk with their GPs about their A: Drugs and alcohol really are a health substance use or misuse, without the police issue and they need to be seen this way. Of course, if they lived anywhere else, having to be involved. The war on drugs is a losing battle that can it would be very different. Local youth do never be won, particu- have high intake of both drugs and alco- larly if it stays as a ‘law hol. It is a serious problem in Byron. and order’ or policing Q: Clearly, doing schoolies - issue. whether here, the Gold Coast, Bali There are many etc - is a ‘rite of passage’. Do you police, even senior think the way this is marked is ever ones, who also agree likely to change significantly? Is with this and have said there a socio/economic dimension - so publicly. We need obviously it costs to be able to head to change the laws and off to schoolies. Is it a middle-class allow for safe drug-test- phenomenon? ing stalls at festivals A: Schoolies has been around for over and other events. 30 years. I personally went to Schoolies on Every single one of the Gold Coast 35 years ago, with a group our BUDDI Community of around 100 other young people from Schoolies HUB volunteers having first aid training with St John’s trainer, Julia Drug Action Team Toowoomba. Who knows, maybe we even and our Schoolies HUB started it! There is a lot of misconception with Volunteers also feels this Young people do see this as a rite of young people that if they talk with a health way and we hope that in the future. The passage and I honestly don’t know how we professional, or even go to the hospital BUDDI CDAT will be involved in these could stop this from happening. However, regarding problematic drug use, that police types of initiatives at local festivals and each destination is different and for the have to be involved. local high traffic events. I young people coming to Byron, they tell t’s a no-brainer that giving education and us they chose Byron and not destinations I also think that talking with their young patients in a way that destigmatises and coming from a harm-minimisation angle such as the Gold Coast, because they is a far better option, than just policing wanted to have a more chilled out holiday. ’normalises’ their drug or alcohol misuse, helps to have the young people understand and seeing everyone who uses drugs as a Of course the destinations do differ that they aren’t alone and that many young criminal. when it comes to how much they spend. people go through these issues, and that Matt Noffs is completely right with Here in Byron the costs are higher than there is effective help for them. regards to the scare-tactics that have been say on the Gold Coast, as our accommo- Interestingly even police see ‘health and used in more recent campaigns, such as the dation is much more expensive, so are the Ice advertisements. They don’t work and in basics, such as food, particularly if they welfare’ as their primary concern too, when having to attend someone who is having a fact they had a detrimental effect, in that dine out. Even the alcohol is more expen- they stopped people from reaching out for sive here. We would like to change the way psychotic episode on Ice or other psychotropic drugs. In many cases, if the person is help. We need to change perceptions and we do schoolies here in Byron in future we need to destigmatise drug use and open years, by creating more ’cultural events in a bad state, the police take them directly to a hospital. up the conversations more, so that people and activities’ for them. will reach out when they need help, either Of course this takes money and Byron “Byron Bay is the only school leavers themselves, or with family members or Bay is the only school leavers destination destination in Australia that receives no friends. state government funding, yet we are the in Australia that receives no state govern- For information on the BUDDI Community ment funding, yet we are the number two number two destination outside of the Gold Coast” Drug Action Team or the Schoolies destination outside of the Gold Coast. We HUB, hubvolunteers@yahoo. hope to change that in the coming years. com.au or call 0402 013 177.

16 | GPSpeak Solving the Troubles of Derry / Londonderry

by Dr David Guest landmark Guildhall. Built in the 1890s it Na Trioblóidí (The Troubles) is the appella- was bombed twice tion given to sectarian violence in Northern during the Troubles. Ireland between the 1960s and the Good Now restored, it is not Friday Agreement of 1998. During that only a tourist attrac- time over 3,500 lives were lost. As with tion, theatre and most armed conflicts, the majority of the function centre but deaths were civilian. remains the home of the council as it has Oh it is the biggest mix-up that you have ever seen been since its incep- tion. For a relatively My father he was orange and my mother she was green small population the Bogside, Derry / Londonderry council is large with One day my ma’s relations came round to visit me police powers by the largely Protestant 38 councillors repre- senting the seven wards of the district and Just as my father’s kinfolk were all police force boiled over into demon- sittin’ down to tea strations, civil disobedience, riots and the four major parties, with four indepen- dents. It takes a lot of talking to get things We tried to smooth things over, but they bombings. The emotional and economic all began to fight toll on the community was severe. done in Derry but at least now everyone has a voice. And me being strictly neutral, I bashed Bogside is the Catholic area in Derry everyone in sight where many of the riots occurred. The Outside the Guildhall is the Peace Bridge linking the western Protestant side of the - The Orange and the Green by murals on the walls of the tenement build- city to the old town and Bogside on the The Irish Rovers ings still record the violence of the time. east. In 2013 the Dalai Lama walked On a recent trip to the United Kingdom across the bridge in the company of and Ireland, I visited the Northern Ireland Protestant and Catholic children. city of “Derry / Londonderry”. It’s dual His charge to them was, “The last name is a poignant reminder of its history century was the century of violence. and the ongoing tensions within the town. This must be the century of peace. My generation’s century is now gone, The city of Derry dates back to the foun- but the future is still in your hands.” dation of a monastery there in the sixth century. The name Londonderry was The Dalai Lama was visiting the chosen by Ulster Plantationists, mainly city at the invitation of Richard Scottish Protestants given land in the north Moore, director of the charity, of Ireland confiscated from native, Gaelic Children in the Crossfire. Moore had Catholics by the government of King James been blinded by a plastic bullet at 1 of Great Britain. This occupation sets the It is said that it takes three generations age ten. The Dalai Lama declared, “There background for four centuries of inter- for a country to recover from civil war. is no other alternative to the peace process. mittent war, assassination and sectarian Throw in religious affiliations and reconcil- There is no other choice - you have to work violence. iation is slower again. and live together, so we should not act like animals.” Northern Ireland was formed in 1922 Our tour guide was a Gaelic speak- following the Irish War of Independence ing, former teacher, practising Buddhist, Derry is living up to that message. The that separated the largely Protestant north Irishman of Chinese extraction. Ronan has Irish group the Cranberries released their from the newly created, Catholic, Irish Free two young daughters and like all parents song Zombies in 1994. It touches on the State (which later became the Republic of wants a better future for his children. long history of violence in Ireland and the Ireland in 1937). Those in the north main- Through his contact with people from all effect childhood deaths have on families tained their strong links with the mainland walks of life he is striving to improve life and society. as is recognised by the UK’s official title of for his family, community and city. Perhaps A few weeks after the song was released, the United Kingdom of Great Britain and it takes “outsiders”, men and women like the Irish Republican Army, after 25 years of Northern Ireland. Ronan, with little religious “baggage” but fighting, declared a cease fire on 31 August a strong commitment to a better future to Tensions arising from job and housing 1994. achieve a breakthrough. discrimination, no universal suffrage, a The full version of this story can be gerrymander and abuse of the extensive Just outside the walls of the old city is the found on the website.

GPSpeak | 17 NEW GOONELLABAH RADIOLOGY CENTRE NOW OPEN! aParking & street level accessaNext to Chemist Warehouse

North Coast Radiology’s new Goonellabah centre, The new centre replaces Orion St branch (closed from staffed by experienced technicians, now open and 4th Nov 2016), while North Coast Radiology’s main Lis- delivering convenient access to key Radiology services more branch at St Vincent’s will commence a Walk-in including: X-Ray service.

aAll General X-Ray including a handy walk-in Service North Coast Radiology, Goonellabah: aA new Digital Dental X-Ray / OPG service 799 Ballina Rd, Ph: 1300 66 XRAY (1300 66 9729) aComprehensive range of Ultrasound examinations Email: [email protected]

PH: 1300 66 XRAY (1300 66 9729) X-RAY l Dental X-RAY & OPG’s l Ultrasound North Coast Radiology - Locally owned and operated since 1974 www.northcoastradiology.com.au

NORTH COAST RADIOLOGY OPENS NEW BRANCH IN GOONELLABAH North Coast Radiology is pleased to Gynaecological, Musculo-Skeletal between Ballina Road and Holland announce the opening of their new examinations eg for sports and St, the new branch is next to The Radiology branch in Goonellabah joint injuries. Abdominal and Pelvic Discount Chemist Warehouse. The on 14th November. This represents Ultrasound examinations as well as convenient location will help those a major enhancement in the Vascular Doppler investigations. travelling in and out of Lismore as availability of quality Diagnostic • Digital OPG Dental Images well as those who live in or near Imaging Services in the Northern – the new facility will boast a state Goonellabah. There is plenty of Rivers region. North Coast Radiology of the art Digital OPG service for parking right outside the front door is locally owned and operated and enhanced image quality for local and all the services are on the one this new branch fits with the overall dentist and orthodontic surgeons. level to support those with prams or objective of delivering services who are less mobile. where they are needed within the The new facility will initially have areas it operates. appointments available between As a result of this new branch 8.30am and 4.30pm Monday to opening, Orion St branch will be While the new facility has space Friday and include a Walk-in X-ray closed and the primary St Vincents to expand the range of Diagnostic service. For patients with time branch will commence a walk in Imaging services over time, initially restrictions it is recommended X-ray service. the following will be included: they book X-Ray appointments • Digital X-Ray – an essential in advance by either calling 1300 INFORMATION CONTACT: Helen starting point for many diagnostic 66XRAY (1300 669 729) or using Spurgeon, Client Service Officer, investigations the online booking facility at www. North Coast Radiology Group, Ph • Ultrasound – including northcoastradiology.com.au. 0488126819, Email: hspurgeon@ key services such as pregnancy, Located at the roundabout ncrad.com

18 | GPSpeak Capture the Fracture Osteoporosis Re-Fracture Prevention Program

Northern NSW Local Health A clinic is currently District has introduced a new being held on alter- Osteoporosis Re-fracture nate Fridays at Prevention Service to the LBH Specialist Richmond Health Service Outpatients Clinic centred at Lismore Base and is aimed at Hospital, alongside simi- reviewing patients lar programs in Tweed and not already receiving Grafton. appropriate management of their bone The program has employed health. The clinic not Craig Knox as The Fracture only looks at pharma- Liaison Co-ordinator to cological treatment identify people aged over 50 but addresses other following a minimal trauma major risk factors fracture (MTF) or fragility such as falls risk, fracture, and then along with poor diet and lack Dr Julia Lisle (Staff Specialist of exercise. Patients Geriatrician) investigate will be provided with and initiate treatment and an education session management of their Bone Craig Knox and Dr Julia Lisle and referred to other Health. services such as falls The program is based on the ACI model All evidence based guidelines highlight the prevention programs, allied health and of care for Osteoporotic Re-fracture need to intervene at the time of the first community exercise programs as deemed Prevention which shows that people are fracture. National audits are showing that appropriate. only 20-30% of such patients are being more likely to adhere to treatment for oste- For further information, please contact identified and treated oporosis if they are case managed. Craig Knox on 0447 287 619. If you wish Osteoporosis is an under recognised North Coast Health Pathways have to refer to the service please address refer- chronic disease. Current statistics are up to date strategies in the management of rals to Dr Julia Lisle, osteoporotic showing that 46% of people who have a osteoporosis. re-fracture prevention clinic and MTF over 50 will re-fracture within 2 years. fax to 02 6620 7307. Family Support for ICE users

‘Yarning about Crystal Meth’ Mission Australia • Family Drug Support provides 24 hour, 7 Discussion Groups - Goonellabah days a week telephone support to families Mission Australia offer a family and carer in need due to drug and alcohol issues. Call The North Coast Primary Health Network program of people with a mental illness 1300 368 186 in collaboration with local services and and/or drug and alcohol issues. They • Alcohol and Drug Information Service organisations has begun a topic and discus- provide support across the entire (ADIS) operates 24 hours, 7 days a week to sion group for community and family North Coast. The Lismore region contact provide education, information, referral, members – ‘Yarning about Crystal Meth number is 02 6623 7401. counselling and support. Anyone can call (‘Ice’) in our Community’. The group runs on 1800 422 599. on Tuesday mornings from 10 – 11:30am NARANON • Counselling Online is a free, 24 hour, 7 at the YWCA in Goonellabah (101A Rous NARANON is a self-help group for fami- Road). Attendees can hear personal stories days a week online counselling service for lies affected by loved ones who use illicit people using alcohol and other drugs, their and information from experts and guest substances. To find local groups contact 02 family members and speakers as well as have opportunities for 8004 1214. friends. sharing and support. State Wide Services Anyone is welcome. For further infor- PHN senior project mation please contact Sam or Kim on 6627 The following state-wide services may be officer, Substance 3300 or email [email protected] able to assist families by providing referrals Misuse Program, for family support and assistance: Samantha Booker.

GPSpeak | 19 GOLD COAST PRIVATE FAST-TRACKS ADVERTORIAL $50 MILLION SECOND STAGE

One of Australia’s largest private healthcare the capacity to continue delivering a world- providers, Healthscope, is fast-tracking class level of care and experience well into construction of the second stage of its $230 the future.” million Gold Coast Private Hospital, just months after opening its doors to patients. Mr Harper said designs for the second

The $50 million expansion will see the hospital go up, increasing some of the building’s height from three to four storeys, and is expected to start later this year, with completion due in late 2017.

Healthscope launched the new Gold Coast Private Hospital, co-located with Gold Coast University Hospital and Griffith University in the thriving Health and Knowledge Precinct, in March, relocating its operations from its previous facility, Allamanda Private Hospital.

The stage two expansion will increase stage were being finalised. - groundbreaking technology that allows its capacity to 340 beds and 23 operating obstetricians to keep track of their patients theatres - up from 284 and 13 respectively.              “The first stage provided expanded from  anywhere via smart devices. services and facilities to those that had The new stage will include a new Day “We also provide a restaurant quality Surgery Unit, surgical ward and expanded been available at Allamanda Hospital and that has been reflected in patient numbers, three-course dinner for new parents to theatre floor, increasing the hospital’s enjoy during their stay. capacity by an additional 10 integrated which have increased significantly since opening,” he said. operating theatres, two procedure rooms “It is a great example of our approach and 56 beds. to healthcare, which is to provide a new level of Gold Coast Private Hospital service and comfort for general manager David Harper patients, a philosophy we said six of the new operating incorporate into every theatres and 30 of the beds aspect of our offering.” would become operational on completion, with the balance Gold Coast Private offers to open in-line with demand. 24-hour Emergency Care Centre, Intensive Care “We had planned to start Unit (ICU), maternity construction of the second and special care nurs- stage in 2018, but have ery, along with services brought that timeframe including cardiac, reha- forward in-line with projected bilitation, oncology, renal patient numbers over the and paediatrics. These coming 12 months,” he said. services are supported “We have plenty of capacity by onsite providers of to take an increased volume imaging, pathology and

       pharmacy. of patients during that time,       “With the Gold Coast’s population  rapidly but have decided to push the button on the expanding, we have added services to There will be no closures to the hospital expansion to ensure we have the facilities meet demand, including maternity and an during construction. available as needed. expanded 24-hour Emergency Care Centre. FOR MORE INFORMATION CONTACT “The feedback from patients, staff and “Our maternity ward offers a PROMEDIA’S KARLA SIMPSON - 0406 doctors using the new Gold Coast Private hotel-style feel, including the latest state- 716 334 OR [email protected] Hospital has been overwhelming positive of-the-art technology such as the first K2 and we are committed to ensuring we have foetal monitoring system for the Gold Coast

20 | GPSpeak GPs score well in Primary Health awards

The professional and community Division of General Practice, a past work undertaken by Northern medical director of the Palliative Rivers GP Andrew Binns has been Care Unit at St Vincent’s Hospital recognized by the North Coast in Lismore, and the inaugu- Primary Health Network (NCPHN) ral Chairman of the Australian in its inaugural North Coast Lifestyle Medicine Association. Primary Health Care Excellence His interest in this subject led Awards. to co-authoring (with Professors Dr Binns, described by NCPHN Garry Egger and Stephan Rossner) chief excutive Dr Vahid Saberi as the book Lifestyle Medicine, with “a quiet achiever in the fields of the third edition now in production. health and the arts”, received an He is a member of the NCPHN’s Outstanding Community Service L-r, Chris Bedford, Assistant Secretary, Primary Health Networks, Department of Health, award Northern Clinical Council and is winner Dr Andrew Binns and Dr Vahid Saberi, North Coast PHN chief executive. recognition at the awards cere- the clinical editor of HealthSpeak mony held in Coffs Harbour on 9 Early Detection of Chronic Kidney Disease and GPSpeak magazines. September. in Aboriginal People – Bugalwena General Practice, Tweed Heads. A keen patron of the arts, he has a special The same award was given to Minjungbal interest in the link between the arts, health Elder and health educator Auntie Sue Category 4 – Promoting Healthy and wellbeing, including arts practices as Follent who retired recently after working Living therapy. He has a longstanding involve- for the Northern NSW Local Health District ment with NORPA and is a strong supporter eVillage – Bay Medical, Byron Bay and for 28 years. of local Aboriginal art, much of which is FerosCare The NCPHN awards recognised the displayed at his practice. diverse projects developed by GPs, allied People’s Choice Award - Dr Vahid Saberi said, “Andrew has an health practitioners and community health Improved Health for the disadvantaged unassuming manner and few know just workers from the Tweed down to Port through the operation of the Winsome how hard he works to support his patients Macquarie. Health Outreach Clinic (Lismore) and other community members - improving their lives through healthy lifestyle changes Award recipients were - Community Choice Award (joint and helping them to become engaged in the Category 1 - Innovation, Integration recipients) - creative arts.” and Partnership Improved Health for the disad- Accepting the award, Dr Binns acknowl- 1 Deadly Step – Casino, a health screening vantaged through the operation of edged the many talented and dedicated event for the Indigenous community, and the Winsome Health Outreach Clinic people he works alongside in the arts and (Lismore), and Early Detection of health fields. No Longer on the BACK BURNER – rede- Chronic Kidney Disease in Aboriginal signing Musculoskeletal models of care on People – Bugalwena General Practice, “There is no better way of gaining aware- the Mid North Coast. Tweed Heads. ness and respect for our Indigenous culture than through art in all its forms and it is Category 2 - Improving Health Care Dr Andrew Binns has been in general heartening to see the NCPHN promote Access and Outcomes practice in the Northern Rivers since health improvement and advance reconcili- 1979. He was a co-founder of Goonellabah ation in this way.” NCPHN Needs Assessment Medical Centre, and also works at Jullums, Lismore Aboriginal Medical Service. He Details and contacts for all Awards Category 3 - Reducing Health Inequity was on the board of the Northern Rivers entries. Widjabul Dreaming conversations

Lismore Regional Art Gallery on 15 Dec @ 5.30pm will host conversations around the paintings of Widjabul artist Adrian Cameron. Dr Andrew Binns will introduce the artist, followed by stories from parole officer Patrick Coughlan. A free event not to be missed. See more information about exhibitions on pages 28-29.

Image shown on right: Dolphin - 1996 - acrylic on canvas board - 75 by 50 cm (framed)

GPSpeak | 21 Local Health Issues - What’s Up?

A partnership between Northern NSW Local Health District (NNSW LHD) Health Promotion Unit and the Northern Rivers General Practice Network has led to local health promotion programs being promoted directly to general practice patients as they wait for their appointments.

“We deliver a range of free, high quality and evidence-based health promotion programs across Northern NSW for quitting smoking, healthy eating and physical activity, reducing risky drinking and preventing falls”, said Gavin Dart, Acting Health Promotion Manager. The scheme is being trialled at the Unit’s”, said Dr Guest of the GMC. “Working in a more collective and coordi- Goonellabah Medical Centre (GMC), where nated way with general practice is a priority images promoting the Units program’s are Displaying health promotion images for us because they have established trust intermixed with the Centre’s own health and brochures can support a general and rapport, and see the people that could messages on the TVs in each of the waiting practice’s demonstration of commitment benefit most from our programs regularly”. rooms. to Accreditation Standard 1.3 – Health Promotion and Prevention of Disease. “Our hope is that having our programs “Unfortunately patients often spend displayed prominently in Northern NSW longer in our waiting rooms than we would NNSW LHD’s Health Promotion program medical practices will result in more people like. At least we can use that time to advise images and brochures are available free to participating to improve their health, and our patients of important health messages, general practices across Northern NSW by ultimately prevent the development of not only from our own organisation but emailing a request to gavin.dart@ncahs. chronic and complex conditions”. also from others like the Health Promotion health.nsw.gov.au. Condom users too cocky about their skills

A sampling of young people at a NSW the North Coast HIV & Related Programs “To our knowledge this is the first study to music festival has found that while 77 per (HARP) and the North Coast Positive demonstrate that young Australian festival cent felt confident about their condom use, Adolescent Sexual Health Consortium attendees, as an identified risk group, may 37 per cent had experienced breakage in the (PASH), interviewed 290 festival attendees, be experiencing a significantly higher rate past year, 48 per cent had seen a condom male and female, aged 18-29 years. of problems when using condoms. slip off during intercourse, and 51 per cent when withdrawing the penis after sex. “When asked where they had learnt about “Despite reasonable levels of confidence condom use, 55 per cent of participants in their ability to use condoms, inconsis- According to Franklin John-Leader, said high school sex education, 27 per cent tent use and a high rate of condom failure Co-Chair of the North Coast Positive from a partner, 18 per cent from packet put this population at an increased risk of Adolescent Sexual Health Consortium instructions, 17 per cent from friends or contracting sexually transmitted infections, (PASH), only 18 per cent of respondents family, 7 per cent from the internet, and specifically chlamydia,” Dr Pit added. reported always using condoms during sex 5 per cent from a health-care worker,” Mr in the past 12 months. John-Leader said. “This study has implications for sexual health promotion and public health This poses significant risks of sexually “Around 34 per cent of interviewees programs, and targeting future interven- transmitted infections (STIs), specifically reported consuming at least ten drinks in tions toward this group may be of value.” chlamydia and HIV, and unwanted preg- the past 24 hours. This group was more nancies, and highlights the need for health than twice as likely to feel confident about UCRH Director, Professor Ross Bailie promotion campaigns targeting this cohort, their ability to use condoms correctly. said, “This is important research with according to the research team from the apparent implications for the health of a University Centre for Rural Health North “Some 94 per cent had been under the significant number of young Australians. Coast (UCRH), Western Sydney University influence of drugs or alcohol during sex It not only has national relevance but is (WSU) and the North Coast Public Health some time in the last year, while 19 per cent particularly timely for the North Coast as Unit. reported being under the influence “most of we move into schoolies celebrations and the time” or “always” when they had sex.” the various music festivals over the holiday WSU medical students undergoing UCRH season.” clinical placements, collaborating with UCRH researcher Dr Sabrina Pitt said,

22 | GPSpeak Former GP to lead University Centre The Lismore-headquartered University non-Indigenous citizens,” Prof Bailie said. success story for both its research work, Centre for Rural Health (UCRH) has chosen which has delivered awards and grants, a former GP to lead the 85-strong regional “While some gains are being made, and coordinating practical placements for institution that coordinates clinical place- there is much to be done. It is important to students in local hospitals, GP practices ments for medical, nursing and allied remember that this is not an issue that just and other clinical settings. health students and undertakes extensive affects remote communities, because simi- research on rural health issues of local and lar statistics apply to Indigenous residents Students come from a range of Australian national importance. here on the North Coast. universities, including main collaborators The University of Sydney, Southern Cross The new Director of UCRH is Professor “A report produced by the UCRH in 2012 University, the University of Wollongong Ross Bailie who practiced as a GP highlighted the difference in health status and the University of Western in South Africa, where he gradu- Sydney. ated in medicine and surgery in 1983, and in New Zealand. Prof They undertake clinical work Bailie is an experienced public across the Northern Rivers, with health doctor and researcher who many taking up positions in this for almost two decades worked region after graduation. This with the Menzies School of Health training makes a vital contribu- Research in Darwin and Brisbane. tion to improving health services in this region and in regional He has extensive knowl- areas across Australia. edge of Aboriginal and Torres Strait Islander health issues, The main UCRH campus and leads the NHMRC-funded is in Lismore, with education Centre for Research Excellence in centres attached to the hospitals Integrated Quality Improvement in in Murwillumbah and Grafton, Indigenous primary health care. Professor Ross Bailie, the newly-appointed Director of the University Centre for purpose-built student accom- Rural Health, North Coast. modation in Ballina, and an increasing Prof Bailie said he is committed to work- between Aboriginal and other people in extension of programs in other towns in ing in partnership with other organisations Northern NSW.” the region. to improve the wellbeing of communities in Northern NSW, naming Northern NSW Fondly recalling his five years in general Prof Bailie expressed appreciation for the Local Health District and the North Coast practice, Prof Bailie said he worked as a new role played by senior staff in the leadership Primary Health Network as two bodies graduate in a rural town in South Africa, of the UCRH prior to his arrival, particu- highly regarded for their work with regional and undertook locums in rural NZ prior to larly acknowledging the important ongoing communities. joining a rural practice as a partner in the contributions made by Professors Michael central North Island. He was a member of Douglas and Megan Passey. “There is now a greater focus on the RNZCGP. Aboriginal health, chronic diseases, mental He also paid tribute to his predecessor, health, ageing, substance misuse and the “I really enjoyed and gained a lot from Prof Lesley Barclay noting the particular role of integrated care planning in keeping this experience, including developing my contribution she has made to maternal and people out of hospital, or shortening their interest in preventive medicine and public infant health and her strong commitment hospital stay,” he said. health,” he said. to improving the wellbeing of Aboriginal and Torres Strait Islander communities on “These initiatives are the way of the “Together with the experience of work- the North Coast. future, and we look forward to contributing ing in A&E and paediatrics in a regional however we can.” hospital in Cape Town, the general practice “There is no doubt that Lesley and the experience was vital to me taking on further wider UCRH team have made a tremen- While noting that important disparities training in public health. dous contribution to the education of between rural and urban areas have “a health care professionals visiting or living damaging effect across the whole commu- “The experience in general practice has in our region, and to enhancing the capac- nity”, Prof Bailie said Aboriginal and Torres also been important to my understanding ity of local services at both the primary and Strait Islander health issues remain a key of the complexities, nuances and challenges acute care levels.” challenge. of general practice, and this has been critical to my research in primary health care, “As the Australian Institute for Health health services and health systems.” and Welfare noted in its recent report, Indigenous Australians experience a Prof Bailie is delighted to be joining an burden of disease more than twice that of organisation acknowledged as a regional

GPSpeak | 23 24 | GPSpeak MyGP TV by Dr David Guest “We waiting, waiting, waiting” bemoaned on Demand also enable other approaches. Con the Fruiterer 20 years ago and we are If you want more customised messages still waiting. How long will it take to see for your patients you can do it yourself. Doctor Smith? “Coupla days” but see Dr Practice specific information and branding Jones today, “Doesn’t madda”. can be supplemented by messages about local services that the practice may wish to When you get to the surgery you check promote. It is not free but the cost of a large in and sit down in the “waiting” room. screen display is readily affordable. It is a Thankfully things have improved signifi- little more work than signing up with the health messages intermixed with current cantly since Con’s time. You no longer have commercial offerings but not a lot, partic- news headlines and lighter items like quick to read the out of date magazines or stare ularly if you partner with compatible local quizzes. vacantly into space. You’ve got “The Girl on organisations. the Train” on your Kindle or Candy Crush The rival is TonicOnDemand from MyGP TV use Google Chromecast devices on the phone. Alternatively, you can even Tonic Health Media (THM). One of its that retail for under $60. Plugging one into read your email on the iPad if you’ve got founders is Australian medical media the spare HDMI port of your TV allows you a good 4G connection or connect to the commentator and presenter, Dr Norman to display a slideshow from your photos surgery’s free wifi. Swan. TonicOnDemand targets the same folders in Google, Facebook or Flickr. The type of sponsors and claims a larger reach The soapies are still playing in some wait- images are drawn down over your wifi and of 10 million people per month, nearly ing rooms but increasingly surgery TVs are internet connections. You can display not half the Australian population. THM also displaying health messages to their captive only your own images but also those from provides pamphlets and brochures to audience. Two commercial companies vie other organisations who have shared their supplement their TV messages. It aims to for dominance in this marketplace. image folders with you. “improve health literacy and patient self Medical Channel describes itself as management by driving evidence-based One such local organisation is the Australia’s Leading Waiting Room Network practice for better outcomes”. It differs Northern NSW Health Promotion Unit “bringing quality medical content to from Medical Channel in that it also offers (HPU). They run programs in alcohol its screens”. With an audience reach of sound capability with its videos. reduction, smoking cessation and exer- over 6.3 million people per month it is cise programs for various age groups. As Both companies allow health messages Australia’s fastest growing network. Its described elsewhere in this issue advertis- from the practice to be included in their ad sponsors include alternative medicine ing the HPU’s programs in GPs’ waiting rotations and neither charges practices for providers, drug and pathology companies, rooms is an ideal way to raise awareness of their services or the equipment. State and Federal Departments of Health their programs in their target audience. and the RACGP. The channel displays The new technologies that underpin TV Group Programs for Anxiety Management for 2017

North Coast general practitioners may not with psychologists from Lismore and from be aware of the MBS items for group the GROW organisation (“Australia’s lead- therapy sessions with a psychologist/ ing mutual help program for people with clinical psychologist. The group sessions mental illness”) to offer local courses next can be in addition to individual therapy year. sessions. The initial group sessions will be run by The item numbers have existed since the Lismore psychologist, Matthew Wagner, start of the Mental Health Care Plan system and offer a six week Anxiety Management although their use on the North Coast has Program. The sessions will be held at health problems. been limited. The item number pays $31 the “GunnaWannaBe” building in South per patient. Sessions consist of 6 to 10 Group based programs have proven Lismore acquired by GROW in 2015. patients and run for at least an hour. successful on the Gold Coast at North Coast GPs should refer new Currumbin Clinic but there are relatively Group sessions offer a time proven and patients to Matthew Wagner initially, to be few groups on the Far North Coast. Dr very efficient way for those suffering from assessed for their suitability for the course. Malcolm Huxtable currently runs groups mental illness. Seeing others in similar Presuming there is sufficient uptake the sessions in Mindfulness at Headspace in situations helps patients to develop the first program will commence in Lismore. However, Dr Nathan Kestevan, necessary skills to manage their own mental February 2017. Reference link. general practitioner Dunoon, has liaised

GPSpeak | 25 26 | GPSpeak Teaching professionalism to tomorrow’s doctors

For me there are many student. aspects of teaching students that are joyful and fulfilling. If we feel able, I feel it is very important to discuss Apart from appreciating errors in clinical reasoning or students’ contagious youth- even dealing with the process ful enthusiasm for life and of complaints to AHPRA. In learning, it is heartening our litigious society it is not to have the opportunity to unlikely that doctors will influence the medicine of the experience this. future. Reflecting on these situa- Over my career there tions may not only prevent have been significant shifts them making the same error in the doctor/patient rela- but also reduce the sense of tionship. There is more isolation and shame that we emphasis on patient centred all feel at those times. I have care, shared decision-making and profes- The “hidden “curriculum” plays a signifi- just sat in on a consultation where the sionalism. General Practice is a wonderful cant part in this equation. patient described her grief about how she environment to teach these skills. It is and her partner had been treated prior to It is therefore worth remembering that generally accepted that professionalism her partner’s death. This was an opportunity we need to be aware of our own professional is better taught by demonstration than for a rich discussion about professionalism, behaviours when we are teaching students. through lectures or reading. In this we communication and ethics. This goes beyond the basics like dress code need to be aware of the so-called “Hidden and punctuality to our relationships with Curriculum”. Professionalism is a part of the “Art of staff and patients, to our practice of patient Medicine” and General Practice gives us This term is used when what is demon- orientated care and to our demonstration multiple opportunities to explore this with strated in medical management in the of our own self-care. our students. Students return from their clinical setting does not correlate with General Practice rotations full of stories, A useful tool is to take the opportu- what is being taught in theory, what mostly very excited by what they have nity to discuss “critical incidents with students have been led to believe is optimal learned in the community at all different students”. This may be something in the patient care, communication, inter-pro- levels. students’ behaviour or comments, such as fessional behaviours, medical ethics or the ever-frustrating use of smart phones professionalism. during consultations. It may be discussing by Dr Jane Barker Beyondblue demonstrated an increas- how we deal with difficult situations like ing level of cynicism developing in medical doctor shopping or angry patients. It may students, particularly during their clinical be opening the discussion about treating Dr Jane Barker is years. friends and family. Academic Lead – General Practice, This has been ascribed to the confron- Sometimes we make treatment choices University Centre tation between idealism and the reality of that do not follow guidelines and it is for Rural Health medical care the students are witness to. important to explain our rationale to the North Coast

Rural General Practice Grants

Federal Member for Page Kevin Hogan said the Coalition Government will provide more than $13 million in infrastructure grants for existing general practices in regional, rural and remote Australia to teach, train an retrain our next generation of health workers. “General practice in regional community’s like ours faces unique challenges in healthcare including the ability to attract and retain a health workforce,” he said.

Read more on NRGPN website

Link to Dept of Health tenders

GPSpeak | 27 exhibitions hail end of an era

Madeline Kidd Nathan Gooley René Bolten Adrian Cameron: Frankenstein and the Various arrangements of colours and shapes #1 Reflection in the Mirror 3 Clever Man 1 Mermaid meet Wolverine 2016, oil on canvas 2015, acrylic on canvas 2016, screenprint on paper 2016, archival pigment print on rag paper The end of an era approaches has been a lifesaver in healing Meanwhile in the Vicki Fayle with the last suite of exhibitions from a traumatic childhood and support organisation R.E.D. Gallery, Melbourne husband at Lismore Regional Gallery early life in gaol. Inc. Studios. In recognition and wife duo Madeline Kidd in Molesworth Street. After of his talent and passion, and Masato Takasaka are sixty-three years in the current Standing in front of Adrian’s Nathan received a 2016 transforming the space into an ‘temporary’ Trench build- artworks you are entranced by Accessible Arts Small Arts exuberant and highly coloured ing, the last four exhibitions the rhythms of intricate dot Grant to realise this project. Playroom which is sure to be foretell of the diverse program- patterns, radiating from the You can support Nathan too a hit with children and adult ming that will be a hallmark painting’s central characters. by buying original works on audiences alike. Walls, floor and of Lismore Regional Gallery The artworks, which take as paper, limited edition screen- ceiling will be festooned with when it reopens its doors at much as six months to paint prints, tea towels and t-shirts colourful and playful paintings, the Lismore Quadrangle in late using a matchstick, create an for friends and family this prints and constructions. 2017. optical quiver, reinforcing the Christmas. power of local dreaming stories. With such a diverse array of Upstairs sees the 20 year There is no escaping the Clever The highly anticipated solo exhibitions there’ll be some- retrospective Widjabul Man as he looks at you directly exhibition Paintings & thing to suit every age group Dreaming by Bundjalung out of the painting. Drawings by local painter and taste in art from powerful painter Adrian ‘Cheesy’ René Bolten in Gallery storytelling to pop culture, from Cameron. A testament to the Downstairs, Gallery 2 1 includes delicate and enigmatic to playful. Lismore significance of Aboriginal features local emerging artist brooding still lifes, abstract Regional Gallery shines culture and the power of art in Nathan Gooley’s Superheroes drawings, figures and faces. strongly to end an era. healing, Adrian’s meticulous and Monsters. Pop culture The mastery of his medium Contact Fiona Fraser, Curator, and mesmerising paintings images of his favourite super- is sure to impress those Lismore Regional Gallery, fiona. depict local animals, spirits, heroes and old school movie seeking an accomplished art [email protected]. sacred places and dreaming. monsters combine seamlessly experience. René will also be au | 02 6622 2209 His mastery of colour and bold with self-portraits of Nathan holding a workshop in still as an ‘X-Man’. Nathan uses life painting on Sunday 22 compositions leave you with no Opening Event: Friday 9 a variety of individual and January 201, for bookings doubt about Adrian’s self-disci- December 2016, 5:30pm for 6pm inventive techniques to create contact Lismore Regional pline and dedication, where art speeches art in his studio at disability Gallery.

SHOWING AT LISMORE REGIONAL GALLERY (10 December 2016 – 4 February 2017) Vicki Fayle Gallery & 24:7 Window Space – Madeline Kidd & Masato Takasaka :: Playroom Gallery One – René Bolten :: Paintings & Drawings Gallery Two – Nathan Gooley :: Superheroes & Monsters Upstairs Gallery - Adrian ‘Cheesy’ Cameron :: Widjabul Dreaming

28 | GPSpeak Art talent breaks out to the mainstream

One of the most unusual art attraction, has hosted Behind the exhibitions to be staged in the Wire, showcasing artworks by area opens at Lismore Regional prisoners in the NT’s correctional Art Gallery in December. facilities. The exhibition is invari- Widjabul Dreaming is one of ably a sell-out, further proof of the last shows to be held at the the Territory’s - and the nation’s Molesworth Street building - incarcerated talent. prior to the opening of the city’s grand new exhibition space in The late Dr Pamela Johnston, a mid-2017. well-known Aboriginal artist, did extensive teaching in jails using A 20-year retrospective exhi- art workshops for healing and bition by Bundjalung artist empowerment of Aboriginal pris- Adrian Cameron (two of whose oners. In an essay “Talking You paintings appear at right), the Talking Me Talking Aborigine” show features many works she wrote: created while the artist was ‘Through painting and the in prison - he is now free, and Numahl – 1996 – Acrylic on canvas board – 52 x 42cm (framed) continues to paint. exploration of culture and identity my students have The intimate connection been led into a desire for a of Aboriginal people with the wider language. Given current land, environment and spirit recidivism rates many of my of the Dreaming is encapsu- students have become quite lated in Adrian’s meticulous and skilled. It is a sad indictment mesmerising paintings, done that young Aboriginal people with a match stick dipped into have more chance of being acrylic paints, one dot at a time. exposed to structured educational processes inside prison He likens the technique to an than they would outside prison. “astral journey to his culture”, producing a calming, therapeutic Where traditional European effect. Painting played a signif- society is a literate society – by icant part in maintaining his that I mean that written word spirits during his long confine- is the predominant language ment, Adrian says, adding that of communication, documen- without this activity his despair tation and expression, for would have led him to the point Mulla Jullums on Journey (Finding Your Soulmate) – 2009 – Acrylic on canvas – 70 x 55cm Aboriginal individuals and of contemplating suicide. art is a positive note amidst the generally communities a visual language fulfills bleak prison experience for Aboriginal that role... This is where Aboriginal art A collection of his jail paintings done people. classes are so important, particularly in a in 1996 resurfaced recently and has Correctional setting and this is their differ- been restored and reframed for Jullums, However, there are seldom opportu- ence from the non-Aboriginal art classes, Lismore’s Aboriginal Medical Service. nities for non-Indigenous people to view which I emphasise here, also have a vital Along with newer work, these will be on such works, and in so doing to gain a role to play in education and in society.’ loan for the exhibition. deeper understanding of the importance of Aboriginal culture. “Where one heads in life depends to a “To see a group of these paintings significant degree on opportunity, but there together is a chance to appreciate the In Victoria there is now legislation that is a deeper intrinsic force and spirit driving delicacy and spiritual power of the work,” will allow Aboriginal artists in prison to be those who are born without opportunity,” says Dr Andrew Binns a long-time fan of able to sell their art . This has the poten- says Dr. Binns. Adrian’s work. tial to provide some much-needed income and to bolster a sense of meaning and “Like so many others he’s using his It is well accepted that meaningful activ- purpose for the creators of the works. creativity to build resilience and wellbe- ities for prisoners are important and can ing. His exhibition is an inspiration and lead to less likelihood of recidivism after For the past 15 years, Darwin’s now one that can take you on a journey to the release. The therapeutic value of creating closed Fannie Bay Gaol, a grim tourist ancient past.”

GPSpeak | 29 Spacing Organs at Risk: Reducing Rectal Side Effects in Prostate Radiation Therapy

Professor David Christie and spaceOAR ADVERTORIAL

Radiation therapy for solidifies within seconds then liquefies, allowing it prostate cancer is daunting. into a hydrogel that pushes to be absorbed and cleared The thought of the potential the rectum away from the from the body within 12 side effects that may come prostate, thus reducing months. with radiation treatment can toxicity. At our Gold Coast locations cause anxiety. Thankfully, This procedure reduces Tugun and Southport, here at Genesis CancerCare radiation exposure to the Professor David Christie we are offering the latest rectum and related side (MBChB FRANZCR) is our technology to allay the fear of effects during Intensity specialised Radiation potential rectal toxicity. Modulated Radiation Oncologist for prostate Therapy (IMRT) or carcinoma. He has a special Volumetric Modulated interest in urological cancers Arc Therapy (VMAT) for including brachytherapy for prostate cancer. prostate cancer.

SpaceOAR is placed by Dr Selena Young and Dr About Professor David Christie David qualified in Medicine from New Genesis CancerCare is urologists during the Sagar Ramani are also Zealand’s University of Otago in 1987 and pleased to offer SpaceOAR same procedure as gold available at our Gold Coast completed Radiation Oncology training in Sydney in 1995, at which time he moved to suitable prostate cancer fiducial marker seeds centres for consults on to Queensland and commenced full-time (used for positioning the prostate carcinoma and practice. He is actively involved in research patients. SpaceOAR is a liquid including national and international clinical that is injected between prostate during radiation spaceOAR placement. To trials. He is the editor of a Radiation Oncology medical journal and has published over 100 the prostate and rectum therapy treatment). The find out more please call our research papers. He has research and teaching under ultrasound guidance. hydrogel maintains space GCCQ Southport Centre on roles with the University of New England as well as Bond and Griffith Universities. Once injected, the liquid throughout treatment and (07) 5552 1400 or Tugun on (07) 5598 0366.

30 | GPSpeak GP Synergy 2016 Outline

The last twelve months have been a time arrangements. of significant change for all involved in GP training - supervisors, practice staff, Attendance at any module of GP registrars, and stakeholders, and GP Synergy’s professional development Synergy staff. program commencing in 2017 is encouraged and will be fully paid, in addition The tender outcome on 6 October 2015 to travel and accommodation subsidies left little time to transition from six sepa- where required. There is no limit to the rate Regional Training Providers (RTP) number of education sessions that may to one. Regional forums were held with be attended. However, support is limited staff, supervisors, practice staff and other to GP Synergy’s professional develop- key stakeholders within each RTP across ment suite, including foundation and NSW and the ACT to discuss the immedi- advanced education modules. ate changes. Increasingly, supervisor professional More than 80 new staff joined GP development will be delivered in both Synergy in the first three months of 2016. face-to-face and online delivery formats A large percentage came from outgoing to accommodate individual circum- RTPs, and two thirds of GP Synergy’s stances and the preferences of the medical education workforce are experi- supervisor. enced educators originating from prior RTPs. GP Synergy has partnered with MedCast to provide supervisors and There is no doubt that this is the John Oldfield, GP Synergy CEO registrars with “Support GPT”, an online biggest change in medical training since education resource that supports in-prac- 2001/2002 when the program was this requirement. tice teaching and is integrated with GP divested from General Practice Education Synergy’s education program. Again, this Australia (GPEA), a subsidiary of the Royal Supervisors and registrars do have a resource is offered, not mandatory. Australian College of General Practice voice in the ongoing development and (RACGP), to the newly formed regional delivery of GP training. Each of the seven Direct phone lines have been established training provider network. subregions has its own regional advisory in all regional offices, including direct council that meets to consider the health extensions to dedicated practice and regis- To ensure responsive education delivery workforce and educational needs of their trar support staff. This will assist practices that is targeted towards meeting the needs respective region. These councils include and registrars to reach the right person in of the local community, we have main- the subregion’s Supervisor Liaison Officer the fastest possible way. tained a regional focus across NSW and the and Registrar Liaison Officer amongst ACT. other relevant peak bodies. GP Synergy’s online training management system GPRime is currently We have retained a regionalised train- At the mid-year North Coast Regional undergoing useability and user acceptance ing program aligned with Primary Health Advisory Council meeting, a recommenda- testing. A program is in place for its rede- Network boundaries. tion was made to re-classify ‘Group C’ – an velopment that will result in improved area around Tweed Heads. All Advisory useability. Supervisor and registrar inter- Within seven subregions, we have Council recommendations undergo a faces have been prioritised. commissioned local offices (Ballina, process of due diligence and scenario test- Armidale, Moree, Newcastle, Dubbo, ing before they are adopted. These are just some of the enhancements Wollongong, Chippendale, Newcastle, to be rolled out in 2017. In addition, we Liverpool and Wagga Wagga). During 2016 we have planned for a more will continue to develop and deliver locally targeted professional development program informed education and to use evidence The number of weeks in a hospital term to commence in 2017. The importance of based population health and workforce is determined by the hospital and the this support, amongst other developments, data. We continue to consult with all our Health Education Institute (HETI). Each is reflected in our research and is resulting stakeholders and build on the legacy of our regional training organisation is bound in some exciting new developments. former RTPs to continually improve health to upload the NTCER, a document that outcomes for our local communities. historically prescribes part-time in-prac- Supervisor professional development tice teaching requirements for registrars will remain non-mandatory, albeit a The full version of this article which is exactly half that of a full-time principle that supervisors do engage profes- can be found on the GPSpeak term. Likewise, teaching payments reflect sional development under contracting website.

GPSpeak | 31 1-in-4 say some medical interactions unnecessary

The interim report of the Federal made from time-to-time to keep it healthy help the clinicians working on the MBS Government’s clinician-led review and up-to-date with modern medical Review to ensure rules around Medicare of all 5700 items on the Medicare Benefits practices.” items reflect modern, integrated clinical Schedule (MBS) has found that one in practice.” every four surveyed patients believed they Ms Ley said the aim was to deliver or an acquaintance had received, or been “the right balance for health profession- Ms Ley said the results also supported recommended to have, an unnecessary als, patients, taxpayers and the future of the Government’s intention that the review consultation, medical procedure or test. Medicare in general… The MBS Review, was not just about removing low-value combined with rolling out the Turnbull or outdated The report released on 6 Sept by the Government’s Medicare Health Care items from Minister for Health and Aged Care Sussan Homes and the revamped My Health the MBS alto- Ley resulted from consultations with 2000-plus health professionals and “This independent clinician-led Taskforce patients across stakeholder forums, writ- is committed to ensuring the right patient ten submissions and an online survey. gets the right test at the right time” The 14-member taskforce is chaired by Prof Bruce Robinson, Dean of the Sydney Record, aimed to cut down on low-value gether, but Sussan Ley Medical School, with former AMA head Dr use of MBS items through a greater focus equally ensur- Steve Hambleton as deputy chair. Its stated on integrated care and stronger rules, ing the rules aim is ‘To ensure that the Medicare Benefits education and compliance.” around a common item’s usage reflected Schedule provides affordable universal best clinical practice targeted at the appro- access to best practice health services that She added, “For example, our Medicare priate patient cohorts. represent value for both the individual Health Care Homes will see a patient with patient and the health system.’ chronic illness sign up with one GP who The report found: “Reported ‘low-value will manage all of their integrated health services’ were very rarely inappropriate The results also showed that 93 per care needs, cutting down on the potential for all patient groups; more commonly cent of the surveyed health professionals for duplicate tests and procedures. the complaint concerned the provision of considered parts of the MBS to be out-of- services in circumstances where for that date, while one-in-two nominated specific “The same goes with having an electronic particular type of patient the benefits did Medicare items they believed were used for health record that patients can use to share not outweigh the risk or costs. “low-value purposes”. information with their GP, specialist, phar- macist, psychologist, practice nurse and “This independent clinician-led Taskforce In a reflection of how the recent election emergency department doctor to ensure is committed to ensuring the right patient campaign had confirmed the importance they’re all on the same page regarding gets the right test at the right time. of public healthcare to Australians, the everything from medical history through Minister said, “We appreciate and under- to recent tests, scans, prescriptions and “That’s why it has established around 40 stand Australians consider Medicare allergies. Clinical Committees and working groups, essential,” adding, “however our consul- with more than 300 clinicians actively tations also show health professionals and “In return, our work on Health Care involved in examining the MBS the public understands changes need to be Homes and the My Health Record will items they use on a daily basis to ensure we get this right first time.”

32 | GPSpeak Order in the House by Kevin Hogan, MP for Page

It was great to be at the opening of the have access to this life changing drug. Regardless of upgraded Lismore Base Hospital with the how healthy and Health Minister Sussan Ley last week. I am proud to be part of the Government fit we feel, as we that has allowed this to happen, and proud age you are at The $80 million redevelopment of the to be part of the Nationals team who increased risk of Base Hospital, which serves the entire listened to the community and pressured contracting seri- Northern Rivers, is great news and for this change. ous illnesses. represents a new era in healthcare for our community. I have had numerous discussions with The start of the National Shingles people across our community who are look- Vaccination Program is a major invest- The upgraded Emergency Department ing forward to being able to access this life ment by the Coalition Government in has an expanded Emergency Medical Unit changing drug without fear of prosecution. the National Immunisation Program to and a new Ambulance Bay and Drop-Off improve the health of older Australians. Zone, as well as an express Community Medicinal cannabis can be a life chang- Care Clinic, a new Renal Dialysis Unit, ing treatment for childhood epilepsy, With the introduction of the shin- a Pathology Unit, a Satellite Imaging symptoms associated with chemotherapy, gles vaccine, the National Immunisation Department and increased hospital parking and multiple sclerosis. There is also grow- Program now provides free vaccines just across the road. ing evidence of cancer prevention and for eligible people against 17 infectious treatment. diseases. This upgrade has been a long-time  coming and I would particularly like to The Government recognises that people thank all our nurses, doctors and allied There was some wonderful news for want assurances that the vaccines they are medical staff who have cared for commu- older members of our community, with receiving today are safe. This is why we are nity members under sometimes difficult the Federal Government announcing those investing in the AusVaxSafety National situations. They have always put the needs over 71 years of age can now get the shingles Surveillance System. of their patients ahead of their personal vaccine for free. comfort, and I thank them for that. This will be a world-leading surveillance Shingles vaccine will now be free to system providing real-time feedback on  eligible people, with a catch-up program NIP vaccines, enhancing the overall quality of vaccine safety in Australia. Medicinal cannabis transitioned from available for adults aged 71 to 79 years. a prohibited substance to a controlled This new National Shingles Vaccination For more information about the NIP substance last month, meaning potentially Program is an important reminder that and the NIP schedule, visit the Immunise hundreds of thousands of Australian’s will vaccinations don’t stop at childhood. Australia website. Red ribbon day for Lismore Base Hospital After the expenditure of often seen through an “urban $80.25 million in federal prism”, she views rural funding, a further $20 million communities as a “number from the NSW Government, one priority”. and years of community State counterpart Jillian and health service advocacy, Skinner said when the LBH Lismore Base Hospital has redevelopment is finished taken another step forward - the NSW Government with the official opening has committed $180 million of Stage 3A of its major to Stage 3B, including new redevelopment. theatres, wards, ICU, birth-

This latest phase includes (l-r) Dr Brian Pezzutti, NNSW LHD Board Chair, Page MP Kevin Hogan, Federal Health Minister Sussan Ley, NSW Premier ing and nursery, and medical a new ED, nearly four times Mike Baird, NSW Health Minister Jillian Skinner and Lismore MP Thomas George. imaging - the hospital will be bigger than its predecessor, opposite the new building. the envy of rural NSW. an expanded emergency medical unit, a Health Minister Sussan Ley, who holds a Long-serving Lismore MP Thomas new ambulance bay and drop-off zone, a rural seat, called federal MP Kevin Hogan George noted that the 12-storey south new renal dialysis unit, express community a “fierce and feisty” advocate in Canberra, tower, with its helipad, is now the tallest care clinic, pathology unit, satellite imag- adding that while health service delivery is structure in Lismore. ing department, and increased parking

GPSpeak | 33

WORKPLACE Phone: 1300 212 555 Fax: 02 66 244 071 INJURIES RECOVERING FROM A WORK PLACE INJURY – OCCUR DAILY EXERCISE PHYSIOLOGY – THE LINK TO A IN AUSTRALIA. SUSTAINABLE RECOVERY. 90% of serious Alysia Bonnett, AEP ESSAM claims were When an individual suffers a serious work place injury there are several factors that need to be considered to ensure a sustainable return to work. For this individual, diagnosed as just 4 weeks completely off work reduces their chances of returning to the same role by 50%! musculoskeletal

The physical injury is the focus in the initial stages of rehabilitation, and quite often injuries or the injured worker can make a full recovery or return to some form of work within a few days or weeks. However, for those who do not show signs of improvement and disorders. do not return to work in some capacity quickly other factors begin to play a role in the recovery process.

These psychosocial factors can significantly impact the success of the individual’s 33% of these physical recovery. The stress of not being able to work and provide for their family. injuries were as a The anti-social nature of being removed from the work place. The other injuries and conditions which can set in as a result of being less active, such as weight gain, result of lifting and overuse injury to opposite limb, postural imbalances caused by altered movement patterns. Are all factors to be considered as part of the rehabilitation process. handling.

The role of an Exercise Physiologist in Workplace injury rehabilitation:

Exercise Physiologists play a crucial role in the rehabilitation of work place injuries. Laborer’s have the Firstly, when addressing the initially physical injury, an Exercise physiologist will prescribe functional based exercise to achieve a quick, yet sustainable return to highest frequency work. Fascia release and mobility exercises will often be necessary to reduce muscle and fascia tightness which often accompanies musculoskeletal injuries and rate of injury. are the underlying cause of joint dysfunction and altered movement patterns.

Education is also an important aspect of work place injury rehabilitation. An Exercise Physiologist should include functional lifting, carrying, and manual Most common Site handing training for injured workers returning to physical roles. Or correct posture and work station alignment for individuals working in a role requiring sustained of injury: positions for long periods. 22% Back For many injured workers, mental illnesses including anxiety and depression are diagnosed particularly if they are never able to return to work. The success of 13% Hand exercise therapy in treating or providing a coping strategy for mental illness is well 11% Shoulder documented. An Exercise Physiologist can play a critical role for these individuals, to allow them to live a relatively normal life outside of the work environment. 10% Knee In order to help your patient achieve a long term sustainable return to work, contact Embrace Exercise Physiology today! Phone: 1300 212 555 Fax: 02 66 244 071

34 | GPSpeak PRODA - Provider Digital Access

Cards, libraries, readers, dongles, pass- part of the account creation PRODA estab- the profession. words, pins, PUCs and PUKs were the lishes three security questions and answers incomprehensible staples of secure online and links the new identity to an email Once the PRODA has been set up it is connections 10 years ago. They were address and mobile phone number for an easy matter to log into HPOS. Enter needed for the first implementation of the SMS messaging. Activation codes are sent your username and password and then on Australian Federal government’s online via each of these communication channels the next screen the six digit authentication services for Australian health practitioners. and entered back into the online registra- They were hated by end users and rarely tion form by the user as part of the account used in practice. creation process.

code that is sent to you via your preferred communication channel of email or SMS.

Another alternative for this second factor authentication is to use a time- based one-time password algorithm (TOTP). Once activated the six digit code is generated on your smartphone and entered into the authentication screen. Examples of this are increasingly common on the web and TOTP is an option for NRGPN members logging into the GPSpeak website. (See secret key option)

The PRODA Code Generator is available for iPhone, iPad and Android. PRODA logon screen

The Australian government and the The final step is validating your identity Department of Human Services are there- using three personal documents. There fore to be congratulated on implementing are a range of approved documents that a more modern approach to online authen- include the Medicare card, Australian driv- tication. The roll-out of the new service ing license, passport and birth certificate as began a few months ago to little fanfare well as other less frequently used identity but is now available to Australian medical documents. practitioners. The Australian Digital Health Agency has Once your PRODA account has been a helpful guide to creating your PRODA Provider Digital Access (PRODA) created you can link it to your Health account and using it to access HPOS. dispenses with the paper correspondence Practitioner Online Services (HPOS) and passwords sent through the mail. It account in order to access HPOS messages by Dr David Guest also dispenses with the hardware required and programs such as the Practice for the first generation of online security. Incentives Program and DVA programs. Both of these components were significant obstacles to making the system easy to use. Despite the lengthy steps required, regis- tration can be completed in one session The Department has enough information if you have the required documentation about practitioners from its existing data- to hand. This makes for a far smoother bases to authenticate health practitioners process than the previous system’s and and allow them to create a user account. As should result in greater uptake and use by

GPSpeak | 35 Managing Elderly ACF Patients - A Tidal Wave Building

Australia is an ageing popu- home beds is rapidly rising. This fortnightly clinic consists of a lation. There is an increasing The number of people in visiting psychogeriatrican and nurse prac- percentage of elderly. We nursing homes is increas- titioner. The service is primarily aimed at now have more illnesses, ing at a pace, some would providing the general practitioner with more surgery and more say beyond the capabilities treatment advice for their patients with medication than ever. In of our treatment facilities severe, complex acute / chronic illnesses. some cases, this makes for a to handle. The elderly are healthier aged population. In often unable to access their These can include psychiatric illnesses other cases , there are now General Practitioner and/ or of severe anxiety, depression, psychosis, more people with chronic specialists for treatment due cognitive decline (dementia and its associ- illnesses, iatrogenic illnesses, to limited finances, immobil- ated problems) or medication interactions. drug interactions, dementia and loneliness ity issues, and illness problems. Behavioural issues in nursing homes are a issues as they live longer, often outliving frequent reason for referral to the service. their family. Various National bodies have acknowl- Patients are variously assessed in the edged the access difficulties the elderly Ballina ACAT rooms, in their homes, or in Our society also has greater expecta- encounter with treatment of their complex their nursing home. tions, perhaps falsely, to live healthier illnesses. Ballina ACAT is the recipient lives, longer. It appears the elderly, and of a grant to bring psychiatric specialist The service is not widely known and if their younger relatives are unaware that treatment to those elderly most in need underutilised is at risk of being withdrawn. some illnesses are chronic, and death is in nursing homes and the community. It To arrange an appointment for your inevitable. is called The Psychogeriatric Outreach patients, please contact Ballina Program / Clinic In this setting, the demand for nursing ACAT , ph 02 6620 6222. Preparing for a ‘bonfire of the faxes’

“Health has never led of all ages, from in digital transforma- 9 months to 90 tion” noted Martin years, have become Bowles, Secretary for comfortable with the Commonwealth electronic communi- Department of cation tools. Health, on his recent visit to the Northern Increasingly, frus- Rivers. Never a truer trated members word has been said. of the health community have Secure electronic resorted to inse- communication has been available in However, due to the unworkable require- cure communication of patient data to Australia for over 15 years. Yet despite ment to use government digital signatures, general practitioners. While this has the uptake by many specialist and most few GPs send referrals to specialists improved patient management, it falls foul general practices a significant amount of electronically. of Australian Privacy Law for the manage- data still comes to GP surgeries by mail ment of health data. or by fax. Holding medical information in Allied health practitioners and pharma- this “image” format poses two problems for cists have also largely avoided using the Over the last 18 months the Northern general practitioners. existing commercial providers due to the Rivers General Practice Network has cost and difficulties with software setup and sponsored a program to facilitate commu- Firstly, the data cannot be searched or maintenance. nication between surgeries, pharmacies easily reused and summarised. This results and allied health called the Northern Rivers in loss of information both within the One solution is to provide a common web Medical Exchange. practice and in communication with other based platform for sharing information members of the medical community. and communicating with other members The Exchange aims to link those members of the health care team. There have been in the local medical community who are Secondly, image format is more than a number of such solutions in recent not currently using any form of secure tenfold larger. Data management is more years and the North Coast Primary Health electronic communication. The Exchange difficult, with increasing issues in- main Network, in conjunction with the Northern acts as a trusted party to allow commu- taining the safety of the data through valid NSW Local Health District, have partnered nication between its members. It uses backups and restorations. with the global medical communication familiar web and email based technologies company, Orion, to pilot a solution on the and focuses on an easy to use experience for The recently appointed head of the North Coast. its members. Australian Digital Health Authority, Tim Kelsey, has called for a “bonfire of the faxes” The issue for all shared platforms is The Exchange has been undergoing acknowledging that paper format is not making the integration with the practi- development in the Lismore region and conducive to optimal care. The sentiment tioner’s current software seamless. The now links all the major surgeries, most has been echoed by the former president of commercial interests of the electronic pharmacies and many other members of the RACGP, Dr Frank Jones. medical record vendors are at odds with the community including psychologists, this requirement and are a significant road- physiotherapists, podiatrists and exercise There have been many attempts to solve block to facilitating integration. physiologists. the medical data communication problem. Several commercial providers now account Commentators in the medical press have The Exchange is undergoing further for majority of data transfer between defended the fax as the lingua franca of development and testing but is now open specialists and general practitioners. medical communication. However, people to all health practitioners in the Northern Rivers region. Health practitioners inter- ested in joining the Exchange should email [email protected].

GPSpeak | 37 Travel

The two faces of Bali by Robin Osborne

The Indonesian island of Bali (pop: 4.5 unrelated to water. somewhere else, my favourite piece of million) receives around three million holi- the ‘real Bali’ being the hill town of Ubud daymakers a year, around one-quarter of My recent visit was by no means the first where the hotels are charming, the scen- them from Australia. At sunset each day it since the 70s, when I was living in Hong ery gorgeous, the tourists more respectful seems that most of them settle down on the Kong and took someone’s advice to drop of local customs and less likely to be fool- west-facing beaches of the by Bali when returning from Australia. Like ish, apart from those Kuta-Legian-Seminyak who let the simians strip to watch the red climb over them in the ball sink into the Indian sacred Monkey Forest, Ocean. regardless of the health warnings. I’m exaggerating, of course, for the numbers In truth, Bali has are more in the hundreds- many faces, some of to-thousands, but my them obvious - dive yardstick is the scene - tours, fast boats to other if one can use the term islands, golf courses, - back in 1971, on my bars with pumping introduction to Bali, music - others less so, when viewing the famous such as the traditional sunset meant sharing the dances, accompanied beach with almost no one. by haunting gamelan music, that are staged in Reggae was not to be Tourists at Seminyak beach prepare for the sunset show. community spaces. heard, Bintang beer singlets not to be seen. Even the actual Bintang most newcomers, I was captivated. While still undergoing one of the was different, as few of the small shops had greatest tourist invasions ever seen on the electricity, so drinks had to be chilled with The flights went via Jakarta, the capital, planet, it is displaying Indonesia’s most blocks of ice. which had little in common with Bali except positive face to the world, regardless of the for being ruled by the same corrupt regime legal tribulations that sporadically attract I know what you’re thinking - if the ice (Suharto’s) and not having chilled Bintang, media attention. wasn’t made from boiled water, didn’t it at least in the district where I cause diarrhea? Yes, it did, but that was just stayed, which has since been a part of the Bali experience - and despite bulldozed for a freeway. all the changes, it still is, for reasons often As might be imagined, I have fond memories of a hotel named the ‘Hai Kok’ in a lane called Lesser Two Mango Street.

The changes to Bali in four decades have come at a fast clip, in concert with the steady growth in visitor numbers. The southern coast, closest to the vastly upgraded Gunung Kawi rice terraces airport, continues to expand rapidly. First Legian, then Seminyak, became the The current one, involving two Byron ‘new Kuta’, words synonymous with “too Bay people charged with killing an crowded, too crass, don’t go there”. Now off-duty Balinese policeman, ensured we it’s Canggu and beyond - far beyond if you made no mention of living near another want escape the worst of the crush and the place battling to manage a huge tourist terrible traffic. onslaught. Traditional ikat weaving at a village near Otherwise it’s advisable to head Ubud, Bali

38 | GPSpeak Book Review

“The guards needed to be well fed to North Borneo theatre on the participants Fighting Monsters maintain a fast pace that would kill off the and their family members. Sub-headings prisoners.” make clear the areas of focus: ‘The survi- By Richard Wallace Braithwaite vor meets his mate’s widow’, ‘Finding the Amongst the six who miraculously bodies of the dead POWs’, ‘Effects on the Australian Scholarly survived - by escaping into the jungle children’, and so on. ($44.00 online) and being rescued by the Dyaks - was the author’s father, Dick, who would return to Australia (he died in 1986) and over the ensuing decades, not always readily, share stories of army and camp life, the ghastly march and his remarkable escape.

Braithwaite senior had joined the army in June 1940, a week after his 23rd birth- day, and within a year found himself posted to Singapore, and then Malaya, with the 2/15th Field Regiment.

While he would distinguish himself in the field, acting as a gun sergeant, the military career of this “highly intelligent but rela-

tively uneducated man” would soon parallel Dick Braihwaite 7 September 2016 that of the Allied forces at large, starting with the fall of the Malay peninsula and Especially interesting, and a major find Singapore, then progressing into the night- for the author, was the memoir penned marish POW camps at Changi, and North by low-ranking soldier Ueno Itsuyoshi, Borneo to where he would soon be shipped. written ‘primarily as therapy for himself”, and translated with the author’s encour- The book is equal parts family memoir, agement. It was launched by the tourism historical account of the Borneo events minister of the Malaysian state of Sabah in and their aftermath, and the view from the The Japanese Army’s forced death marches 2012. other side of the military fence, drawing in occupied North Borneo in 1945 were on the author’s trips to Japan and inter- “He felt it important that the relatives among the most blatant atrocities of views with family members of some of the knew how terrible it was in Borneo, and WW2, accounting for the deaths of 1787 protagonists. how misguided the Japanese military Australian and 641 British POWs. was… while I do not believe there is such The hidden nature of the death marches Having already suffered appalling condi- a thing as an absolute truth, I do think resulted in relatively slight retribution tions in prison camps, the men - a good Ueno’s memoir is a serious attempt to tell - “undoubtedly many Japanese escaped many of them barely out of boyhood - were an extremely difficult story without fear or punishment because there were no brutally marched along jungle trails, fed favour. witnesses” - although some leading figures starvation rations, offered no medical care, were executed or suicided. One was the “Few people who have been to the and shot or beaten to death if they tried to commander, General Baba, tried at Rabaul extreme of human existence are capable of escape. and hanged. reporting back to the rest of us. His memoir “The Japanese knew most of the POWs is an important example of a successful However, in the postwar political climate, would die,” writes Richard Wallace attempt.” “Many key individuals were let off because (‘Dick’) Braithwaite, a long-time Northern they were useful or potentially useful to the The same must be said of this multi-lay- Rivers resident who died shortly after this Allies,” he writes. ered blend of history and family discovery, detailed (530-page) ‘Intimate History of a complete re-draft of the “anti-Japanese the Sandakan Tragedy’ was published. The most prominent, of course, was diatribe” the author confesses to have writ- Emperor Hirohito. “I suggest that local Japanese devised a ten in 2000, even if, as he notes, there is no doubt about who was responsible for these strategy to kill off all the POWs using the The last third of the book scene-shifts to tragic events. death march,” he adds, saying that the pris- Australia and Japan to examine the psycho- oners carried food for their guards. logical impact of the SE Asian war and the Robin Osborne

GPSpeak | 39