Program
A PDF version of the program is now available here:
Keynote speakers

Lara Fuller
Associate Professor Lara Fuller, MBBS (Hons), FRACGP, GCME, AMusA, is Director of Rural Medical Education and the Rural Community Clinical School at Deakin University, Victoria. As an academic general practitioner, her teaching and research interests are in curriculum design for rural medical education, learning in longitudinal integrated clerkships, rural clinical training pathways and rural workforce outcomes. She is an active member of the Federation of Rural Australian Medical Educators (AusFRAME) and the International Consortium of Longitudinal Integrated Clerkships (CLIC).
Portland District Health services a community of almost 20,000 people. Compared to the rest of Victoria, Portland has greater socioeconomic disadvantage, a higher proportion of people of Indigenous status, and higher rates of hypertension, smoking, alcohol consumption, obesity and psychological distress.
The hospital has 69 registered inpatient beds with a 24-hour, seven-days-a-week Urgent Care Centre (UCC). The UCC is deemed one of the busiest in Victoria, per population.
On 14 June 2018, Professor Paul Worley, the then National Rural Health Commissioner, visited Portland. Portland’s shortage of general practitioners (now critical) was a familiar issue confronting him.
As a result of this visit, Portland decided to ‘grow its own’ rural workforce using the already existing infrastructure, beginning with longitudinal medical student training and ending with advanced skills training posts, eventually producing rural generalist general practitioners to meet the needs of the community.
With the hospital adversely affected, with limited access to International Medical Graduate Hospital Medical Officers due to the COVID-19 pandemic, the timing was opportune.
The outcome of this process is an innovative and collaborative rural generalist pathway with the achieved steps as follows:
- Novel longitudinal internship program. In 2021, interns commenced working for six months in ‘medicine’ and six months in ‘surgery’, but each week begins with a day in the UCC and finishes with a day in general practice. The intern may see a patient in UCC with a FACEM on Monday, follow up care in the general ward Tuesday to Thursday with a physician or surgeon and review or admit patients in general practice with their GP supervisor on Friday.
- PMCV accreditation for a Rural Generalist Year 2 stream. The program comprises a six-month blended community paediatric and obstetric experience, with placements within the hospital, general practice and Aboriginal Medical Service, followed by six months in UCC with support to enrol in ACEM Emergency Certificate and Anaesthetic experience in a JCCA-approved training position.
- Advanced skills training posts in anaesthetics and paediatrics accredited and in emergency currently under development. Partnerships established with Barwon Health and Western Health and South West Healthcare.
- The development of posts that facilitate rural generalist consolidation for each of the above disciplines
The significant beneficiaries of this integrated approach to rural generalist pathways will be the Portland community.

Margaret Garde
In 1985 Margaret Garde arrived in Portland, Victoria, to join her partner, now husband. Being the only female GP, and the youngest by at least 10 years, brought with it a sense of professional isolation.
The disciplines in which she worked included family planning, occupational health, Aboriginal health, public health, forensic medicine, adolescent health and mental health. Now she has a strong interest in teaching and supporting students and doctors who wish to live and work in a rural location, with a strong emphasis on giving them the preparation they need to feel confident and secure.
Thus followed the hosting of a string of medical students, John Flynn Scholars, and cousins, children of friends or anyone else who was remotely interested in medicine as a career.
As is now well recognised, none of these wonderful people returned to Portland to work.
In 2012 the opportunity to work in Portland’s GP SuperClinic presented and, together with this, the ability to host Deakin University students from a rural background who reside in Portland for their 12-month placement.
This, together with a visit from Paul Worley, the then National Rural Health Commissioner, provided the inspiration for our longitudinal rural vocational experience.
Portland District Health services a community of almost 20,000 people. Compared to the rest of Victoria, Portland has greater socioeconomic disadvantage, a higher proportion of people of Indigenous status, and higher rates of hypertension, smoking, alcohol consumption, obesity and psychological distress.
The hospital has 69 registered inpatient beds with a 24-hour, seven-days-a-week Urgent Care Centre (UCC). The UCC is deemed one of the busiest in Victoria, per population.
On 14 June 2018, Professor Paul Worley, the then National Rural Health Commissioner, visited Portland. Portland’s shortage of general practitioners (now critical) was a familiar issue confronting him.
As a result of this visit, Portland decided to ‘grow its own’ rural workforce using the already existing infrastructure, beginning with longitudinal medical student training and ending with advanced skills training posts, eventually producing rural generalist general practitioners to meet the needs of the community.
With the hospital adversely affected, with limited access to International Medical Graduate Hospital Medical Officers due to the COVID-19 pandemic, the timing was opportune.
The outcome of this process is an innovative and collaborative rural generalist pathway with the achieved steps as follows:
- Novel longitudinal internship program. In 2021, interns commenced working for six months in ‘medicine’ and six months in ‘surgery’, but each week begins with a day in the UCC and finishes with a day in general practice. The intern may see a patient in UCC with a FACEM on Monday, follow up care in the general ward Tuesday to Thursday with a physician or surgeon and review or admit patients in general practice with their GP supervisor on Friday.
- PMCV accreditation for a Rural Generalist Year 2 stream. The program comprises a six-month blended community paediatric and obstetric experience, with placements within the hospital, general practice and Aboriginal Medical Service, followed by six months in UCC with support to enrol in ACEM Emergency Certificate and Anaesthetic experience in a JCCA-approved training position.
- Advanced skills training posts in anaesthetics and paediatrics accredited and in emergency currently under development. Partnerships established with Barwon Health and Western Health and South West Healthcare.
- The development of posts that facilitate rural generalist consolidation for each of the above disciplines
The significant beneficiaries of this integrated approach to rural generalist pathways will be the Portland community.

Christine Giles
Chris Giles is a senior executive with considerable experience leading and managing regional, rural and remote health services.
Chris has a strong clinical background as a nurse then midwife, which has proven very valuable in her recent executive roles. These executive roles include working in healthcare organisations in Western Australia, Victoria and Queensland.
Most recently, Chris has worked as the Chief Executive Officer of Portland District Health in south-west Victoria. Prior to this she spent three years living in the Torres Strait, working as a District CEO for Queensland Health.
Chris has a passion for finding solutions to wicked problems, often challenging the normal by finding innovative solutions to improve health service access and quality for rural and remote communities. Some of these solutions include extending scope of practice for clinicians, training cohorts of nurse practitioners and using technology such videoconferencing and electronic health records to overcome distance.
As a sideline, Chris is on the Board of the local catchment management authority, keen to ensure land and water resources are managed to ensure future generations can enjoy them as we do.
Portland District Health services a community of almost 20,000 people. Compared to the rest of Victoria, Portland has greater socioeconomic disadvantage, a higher proportion of people of Indigenous status, and higher rates of hypertension, smoking, alcohol consumption, obesity and psychological distress.
The hospital has 69 registered inpatient beds with a 24-hour, seven-days-a-week Urgent Care Centre (UCC). The UCC is deemed one of the busiest in Victoria, per population.
On 14 June 2018, Professor Paul Worley, the then National Rural Health Commissioner, visited Portland. Portland’s shortage of general practitioners (now critical) was a familiar issue confronting him.
As a result of this visit, Portland decided to ‘grow its own’ rural workforce using the already existing infrastructure, beginning with longitudinal medical student training and ending with advanced skills training posts, eventually producing rural generalist general practitioners to meet the needs of the community.
With the hospital adversely affected, with limited access to International Medical Graduate Hospital Medical Officers due to the COVID-19 pandemic, the timing was opportune.
The outcome of this process is an innovative and collaborative rural generalist pathway with the achieved steps as follows:
- Novel longitudinal internship program. In 2021, interns commenced working for six months in ‘medicine’ and six months in ‘surgery’, but each week begins with a day in the UCC and finishes with a day in general practice. The intern may see a patient in UCC with a FACEM on Monday, follow up care in the general ward Tuesday to Thursday with a physician or surgeon and review or admit patients in general practice with their GP supervisor on Friday.
- PMCV accreditation for a Rural Generalist Year 2 stream. The program comprises a six-month blended community paediatric and obstetric experience, with placements within the hospital, general practice and Aboriginal Medical Service, followed by six months in UCC with support to enrol in ACEM Emergency Certificate and Anaesthetic experience in a JCCA-approved training position.
- Advanced skills training posts in anaesthetics and paediatrics accredited and in emergency currently under development. Partnerships established with Barwon Health and Western Health and South West Healthcare.
- The development of posts that facilitate rural generalist consolidation for each of the above disciplines
The significant beneficiaries of this integrated approach to rural generalist pathways will be the Portland community.

Stan Grant
Stan Grant is the International Affairs Editor for the Australian Broadcasting Corporation (ABC), a multi-award-winning current affairs host, an author and an adventurer.
Well known for having brought the former Prime Minister Malcolm Turnbull to tears when interviewed about Indigenous affairs on The Point, Stan’s keynotes are insightful, engaging, always professional and, at times, controversial.
Stan’s Aboriginal heritage has shaped his dynamic, resilient personality. Born in Griffith in south-west New South Wales (NSW) in 1963, Stan Grant’s mother is from the Kamilaroi people and his father is of the Wiradjuri.
Stan spent most of his childhood on the road living in small towns and Aboriginal communities across outback NSW. His father was an itinerant saw-miller who worked when and where he could. Stan moved so often he attended 12 different schools before he was in his teens.
The early travelling gave Stan a love of adventure and stories. He grew up listening to the tales of his grandfather and uncles and aunts. Despite poverty and an early sporadic education, the security of his family and the larger Aboriginal community gave him a strong platform for life.
After attending university, Stan won a cadetship with the Macquarie Radio Network, launching a career in journalism that has spanned more than 30 years and more than 70 countries. In that time Stan has travelled the world covering the major stories of our time from the release of Nelson Mandela, the troubles in Northern Ireland, the death of Princess Diana, war in Iraq, the second Palestinian intifada, the war on terror, the South Asia tsunami, the Pakistan earthquake and the rise of China.
Stan has hosted major news and current affairs programs on Australian commercial and public television. He has been a political correspondent for the ABC, a Europe correspondent for the Seven Network based in London and a senior international correspondent for the international broadcaster CNN based in Hong Kong and Beijing.
Returning to Australia in 2013, Stan continued to cover international events for Sky News Australia and reignited his passion for telling the stories of his own Indigenous people. He has worked as the Indigenous editor for The Guardian Australia, managing editor for National Indigenous Television and international editor for Sky News. In 2016 Stan was appointed as special adviser to the then Prime Minister Malcolm Turnbull on Indigenous constitutional recognition.
Stan has won many major awards including an Australian TV Logie, a Columbia University Du-Pont Award (the broadcast equivalent of the Pulitzer Prize) and the prestigious United States Peabody Award. He is a four-time winner of the highly prized Asia TV Awards including reporter of the year.
Stan has written The Tears of Strangers and Talking To My Country (Harper Collins), and has published numerous articles and opinion pieces for The Sydney Morning Herald and The Australian.
Stan Grant is passionate about justice and humanity. His years of international reporting have given him a deep understanding of how the world works. He is deeply immersed in the politics and history of Asia and the Middle East. He can link the importance of leadership and the impact of history and, above all, believes in the power and resilience of people.
Stan is married to ABC Sports broadcaster, Tracey Holmes, and has four children. He lives in Sydney.
Booked through: Celebrity Speakers www.celebrityspeakers.com.au

Mark Howden
Professor Mark Howden is Director of the Institute for Climate, Energy and Disaster Solutions at The Australian National University.
He is also an Honorary Professor at Melbourne University, a Vice Chair of the Intergovernmental Panel on Climate Change (IPCC) and the Chair of the ACT Climate Change Council. He was on the US Federal Advisory Committee for the Third National Climate Assessment, was a member of the Australian National Climate Science Advisory Committee and contributes to several major national and international science and policy advisory bodies.
Mark has worked on climate variability, climate change, innovation and adoption issues for over 30 years, in partnership with many industry, community and policy groups via both research and science-policy roles. Issues he has addressed include agriculture and food security, the natural resource base, ecosystems and biodiversity, energy, water and urban systems.
Mark has over 420 publications of different types. He helped develop both the national and international greenhouse gas inventories that are a fundamental part of the Paris Agreement and has assessed sustainable ways to reduce emissions. He has been a major contributor to the IPCC since 1991, with roles in the Second, Third, Fourth, Fifth and now Sixth Assessment Reports, sharing the 2007 Nobel Peace Prize with other IPCC participants and Al Gore.

Gabrielle O'Kane
Gabrielle O’Kane is Chief Executive Officer of the National Rural Health Alliance, the peak body for rural health in Australia. She is an Adjunct Associate Professor with the University of Canberra and Charles Sturt University. Gabrielle has extensive experience in the private and public health sector, which has contributed to her deep understanding of the need for collaborative partnerships to support the rural health workforce and achieve positive health outcomes for rural communities. She promotes solutions to the Australian Government to address the needs of rural communities and health professionals, through her position on many pertinent steering groups and committees.

Roland Sapsford
The Climate and Health Alliance’s new Chief Executive Officer, Roland Sapsford, has been working to respond to the challenge of climate change and the task of reducing emissions through public policy and activism for much of his professional life.
This work has ranged from being involved in New Zealand’s first study of the impacts of carbon taxes and work on energy efficiency and home insulation policy, through to getting solar panels installed on a local community centre and campaigning against major road projects.
Roland once completed four years of a medical degree and was a senior manager in public health for five years. He has also studied economics and systems ecology to postgraduate level, and has a strong commitment to Indigenous rights.

Rabia Siddique
Rabia Siddique is a history-making humanitarian, best-selling author and multi-award-winning international keynote speaker. She is a sought after transformational coach and mentor and speaks English, French, Spanish and Arabic.
Current work
Rabia’s powerful and engaging presentations on leadership, resilience, equality and diversity draw on her personal story of strength, courage and forgiveness, in addition to her legal, military and psychology training. Surviving a hostage crisis in Iraq, Rabia garnered global attention for making the British military accountable for silencing her about her ordeal and role as a military lawyer in releasing captured Special Forces soldiers. Standing up for justice in the face of public ridicule, Rabia’s brave action in suing the British Government for sexism and racism became a catalyst for policy change to ensure a fairer workplace for women and cultural minorities in the British military.
Rabia is an expert commentator, regularly appearing in newspapers and magazines, and on television, radio and online media in Australia and around the globe, including The Guardian, 60 Minutes and ABC television.
With her best-selling memoir Equal Justice also the focus of a feature film, she is now writing her second book.
Rabia is an Ambassador for 100 Women, Angelhands, Esther Foundation, Inner Ninja (mental health support) and Ishar (multicultural health service). She is a Board Member of the International Foundation of Non-Violence, Museum of Freedom and Tolerance, Wesley College and Calan Williams Racing.
Previous experience
Law: Rabia’s extensive career as a criminal, terrorism, war crimes and human rights lawyer has taken her to Europe, the Middle East, South America, South East Asia and Australia.
Military: Her military career includes serving as a British Army officer in England, Northern Ireland and the Middle East. Rabia was one of England’s first Armed Forces Employment Law Officers – a role which took her to Royal Military Academy Sandhurst where she ran equality and diversity training. Among her charges was Prince William, the Duke of Cambridge.

Keith Suter
Dr Keith Suter is considered one of Australia’s most influential global futurists and media commentators in national and foreign affairs. He has also held many strategic leadership roles. Dr Suter is an experienced, professional and awarded presenter renowned for explaining complex global and business issues in a way his audiences can digest and understand. He is in demand as an MC and conference facilitator. Keith’s tailored keynotes, workshops and facilitated sessions are entertaining, highly compelling and always captivating.
In 2019 Keith was proudly appointed as a Member (AM) of the Order of Australia (General Division), for significant service to international relations and to the Uniting Church in Australia.
Previous experience
Academic expert: Dr Keith Suter has achieved three doctorates. The first of these was about the international law of guerrilla warfare (University of Sydney), the second about the social and economic consequences of the arms race (Deakin University) and a third doctorate on scenario planning (University of Sydney).
Leadership roles: He has been appointed to many prestigious roles throughout his career, including Chairperson of the International Commission of Jurists (NSW), Director of Studies at the International Law Association (Australian Branch) and Managing Director of the Global Directions think tank. After 25 years, Keith recently retired from the role of Chairperson of the International Humanitarian Law Committee of the Australian Red Cross (NSW).
Global recognition: He has also been a member of the prestigious Club of Rome since 1993. The Club is ‘an informal association of independent leading personalities from politics, business and science, men and women who are long-term thinkers interested in contributing in a systemic, interdisciplinary and holistic manner to a better world. The Club of Rome members share a common concern for the future of humanity and the planet.’ The club has only 100 members, with Mikhail Gorbachev among them.
Keith is a Life Member of the United Nations Association of Australia in recognition of his service. At various times from 1978 to 1999, he served as the National President of the organisation and took on the roles of WA and NSW State President.
Strategic roles: Keith was the President of the Centre for Peace and Conflict Studies (1991–98) at the University of Sydney, and was a consultant on social policy with the Wesley Mission for 17 years. In addition, he served as a consultant for a number of other organisations with a focus on local and international issues. He is also an active member of the Australian Institute of Company Directors.
Media roles: He frequently appears on radio and television discussing politics and international affairs. He has been, for many years, the foreign affairs editor on Channel 7’s Sunrise program.
Renowned author: Among Keith’s many books are All about Terrorism: Everything you were afraid to ask, as well as Global Order and Global Disorder: Globalization and the Nation-State and 50 Things You Want to Know About World Issues … But Were Too Afraid to Ask.

Susan Wearne
Susan Wearne is a general practitioner (GP) and senior adviser to the Australian Government Department of Health and Aged Care regarding rural health and health professional education. She trained at Southampton University in England and completed general practice training in Northamptonshire and back home in Cheshire. She owned a practice in York, England, and worked at the Aboriginal Medical Service in Alice Springs and for the Royal Flying Doctor Service at Ayers Rock Medical Centre. She has extra qualifications in child health, women’s health, family planning, primary health care and medical education and now works as a GP in Canberra.
Susan is a Clinical Associate Professor at Australian National University and has published over 40 peer-reviewed articles on general practice and medical education. The fourth edition of her textbook Clinical Cases for General Practice Exams was published in 2019. She held educational leadership positions in the Northern Territory before taking on national roles for the Royal Australian College of General Practitioners and General Practice Education and Training. She works in the Health Workforce Division which manages general practice training and other programs that promote Australians’ access to qualified health professionals. She was medical lead for the soon to be released Australian National Medical Workforce Strategy.
Susan’s husband, Tim Henderson, is the eye surgeon at Alice Springs Hospital. Their daughter and her family live in England and their son works in Adelaide. Between flights home to Alice, Susan swims, makes clothes and enjoys the scenery on the lake as she learns to row.

Justin Yeung
Justin is a consultant emergency physician by training. He has had a number of leadership positions in WA Health – director roles in emergency medicine (Royal Perth Hospital, Albany Health Campus and WA Country Health Service) and medical services (Great Southern region of Western Australia). He is currently Medical Director of the WA Country Health Service Command Centre, which incorporates a number of 24/7 clinical streams in acute telehealth – emergency, inpatient medicine, mental health, obstetrics and midwifery, palliative care and acute patient transfer coordination. Justin splits his time between Perth and Albany, and still maintains clinical exposure working in the Emergency Telehealth Service and locums in regional Western Australia. To add some spice to the year, Justin has started postgraduate studies in health care leadership. He’s also an oft-stung beekeeper.
From humble beginnings as a limited-hours, weekend-only, single-doctor emergency consultation service for a handful of small country hospitals in Western Australia (WA), the WA Country Health Service Command Centre is approaching a 10-year milestone of providing specialist-led clinical consultation directly to rural patients using video-enabled technology. The Emergency Telehealth Service (ETS) has grown into a 24/7 virtual emergency department, managing more than 27,000 consultations in 2021. The range of clinical services available to support our regional clinicians using telehealth has expanded to include inpatient care (2018) and mental health (2019), obstetric and midwifery, palliative care and, most recently, transfer coordination (all commenced in 2022). We will present an overview of our 10-year journey, highlight areas of innovation and success, as well as outline challenges we have and continue to face.
Plenary sessions
Opening Session:
Julieanne Gilbert MP
Assistant Minister for Health and Regional Health Infrastructure, Queensland – Welcome to Brisbane
Emma McBride MP
Federal Member for Dobell, Assistant Minister for Rural and Regional Health
Plenary Session 1:
Russell Roberts
Australian Journal of Rural Health
Editor in Chief 2017–21 – AJRH 30 Years
Jason Waterford
HESTA Australia Ltd
Plenary Session 4:
Helen Haines MP
Independent Federal Member for Indi
Closing remarks:
Stephen Gourley
Deputy Chair, National Rural Health Alliance
Concurrent presenters
Lauren Gale
Lauren Gale is the Director of Policy and Programs for the Federation Office of the Royal Flying Doctor Service (RFDS). Lauren is responsible for driving policy, advocacy and engagement activities, informed by RFDS research.
Prior to commencing with the RFDS, Lauren was a Policy Adviser in the Department of the Prime Minister and Cabinet with responsibility areas including rural health, mental health, Indigenous health and women’s health.
Lauren has a Master of Public Policy (Social Policy) from the Australian National University in 2013 and previously completed a Bachelor of Arts and Sciences (Hons) at the University of Sydney.
How do we ensure the best for the bush in health care?
A 2018 report analysed projections in population, health status and health workforce trends in rural and remote Australia, to determine the health status, health service needs and gaps in services over the next decade. Cancer, mental health and cardiovascular disease are predicted to be the most prevalent health concerns over this period, with those in rural and remote areas expected to be most impacted.
The report also found, over the next decade, there will be significant shortages of essential health services in rural and remote Australia. For example, in 2028, projections demonstrate there will be less than one-fifth of the number of general practitioners (GPs) in remote as compared to metropolitan areas (43 as compared to 255 per 100,000 population respectively); just one-twelfth of the number of physiotherapists (23 as compared to 276 per 100,000 population); and half the number of pharmacists (52 as compared to 113 per 100,000 population).
In addition, a follow-up report released in 2020 sought to specifically demonstrate the inequities in access to primary healthcare services currently experienced by those in rural and remote areas.
In the rural and remote context, where there are small populations spread across large geographical areas, it may not be realistic or practical for everyone to have access to permanent local services. However, the Australian Institute of Health and Welfare proposes that all Australians should have reasonable access to services, which it defines to be access within a 60-minute drive time.
It was found that 42,805 people had no access to any place-based primary healthcare services within this 60-minute drive time. Furthermore, when looking at the specific primary healthcare type, it was found that 65,050 Australians had no face-to-face access to a GP; 440,387 had no access to a nurse-led clinic; 142,269 had no access to dental services; and 106,848 had no access to mental health services within a 60-minute drive time.
These reports show that the greater the distance from city centres, the greater the disparity remote Australians face in access to health care, education and facilities. Acknowledging the tyranny of distance as a hurdle in healthcare provision to remote Australians, the presentation will explore the need for further research and collaborations to agree a definition of what is ‘reasonable’ access to health care for rural and remote Australians and how, through innovative service models, we can better ensure equity of access to services.
Sandra Gattenhof
Sandra Gattenhof is Director of Research Training in Creative Industries, Education and Social Justice Faculty at QUT, situated on Turrbul and Yugara lands in Meanjin (Brisbane). Sandra is internationally recognised as an expert in the field of arts and cultural evaluation and has worked as a researcher with major arts organisations and arts funding bodies in Australia, New Zealand, Fiji, the United Kingdom and Norway.
Sandra has an outstanding publications record. Sandra is chief investigator for ARC Linkage Project The Role of the Creative Arts in Regional Australia (2019–22), Social Impact Strategy for the Puuya Foundation (2021–23), and led Valuing the Arts Australia and New Zealand (2020). Sandra has been a lead consultant for Australian Curriculum: The Arts, Education Queensland’s Arts curriculum and syllabuses, Queensland Ballet, Out of the Box children’s festival and Brisbane Festival. Her latest co-authored publication is The Social Impact of Creative Arts in Australian Communities (2021 Springer).
Sandra’s outstanding service record includes past president of Drama Australia and Drama Queensland, chair of the Dead Puppet Society, and board member of National Advocates for Arts Education. Sandra has received the QUT Vice-Chancellor’s Performance Award (2014; 2007), QUT Award for Excellence in Leadership (2014), and Creative Industries Faculty Dean’s Award for Excellence in Research and Innovation (2011). Sandra received Drama Australia President’s Award in 2021.
Leaving no-one behind: creative engagement to enable wellbeing and social inclusion
The past twenty years has seen a dramatic increase in research into the effects of arts and cultural engagement on the health and wellbeing of individuals and communities (Fancourt and Finn 2019: vii). The Creative Health Inquiry Report (APPGAHW 2017) and the ArtPlace America white paper Creating Healthy Communities (Sonke et al 2019) represent two significant recent efforts to assert the role of the arts in advancing health and wellbeing. Both reports advocate community-based and societal approaches to improving wellbeing through the arts, as opposed to individualised approaches.
In Australian communities, our research shows the value of arts and cultural engagement is in social bonding and bridging that allows individuals and communities to develop a ‘sense of connectedness, self-understanding and identity construction, as well as a sense of belonging with, or pride in, one’s community, defined by geography or people’ (Brown and Novak 2007 and 2013). Using outcomes from an Australian Council Research Project (2019–22) investigating the impact of arts and cultural engagement in regional Australian communities, this paper examines the connection between wellbeing and social inclusion through an arts lens.
Locating the examination of wellbeing and social inclusion in community-initiated projects in central-west Queensland, The Lost Art, and north-west Tasmania, Shorewell Presents … Dear Friend, the paper illustrates through these projects how creative and cultural activities maintain social connection and avoid potential social fragmentation. Additionally, the paper will discuss project responses to COVID-19 using both physical and virtual creative art-based engagement strategies in a crisis to entice continued participation and support wellbeing.
Pat Giddings
Pat is the Chief Executive Officer of the Remote Vocational Training Scheme (RVTS), a medical training organisation based in Albury, Australia. Pat has a background in medical education and training administration and established RVTS in 2000. He is a practising clinician, active in Aboriginal health, obstetrics and emergency medicine. He was awarded the Order of Australia Medal in 2017 for service to rural and remote medicine and is a Fellow of the Royal Australian College of General Practitioners, the Australian College of Rural and Remote Medicine, and the Royal Australasian College of Medical Administrators.
Building medical workforce capacity in remote communities: the Mallacoota and RVTS experience
In April 2016, our local GP called a public meeting. Over one-third of the population came to hear of the difficulties she was facing as the only doctor in a town with a permanent population of roughly 1,000 people.
What we heard shocked us – the practice was facing closure as she was overworked and yet unable to make ends meet. To address these issues the Mallacoota Community Health Infrastructure and Resilience Fund Inc (CHIRF) was formed.
In 2018 CHIRF formed an alliance with the Remote Vocational Training Scheme (RVTS) and became the first town in a targeted-recruitment pilot strategy, to recruit, retain and train doctors to GP Fellowship in remote communities, via a supported model of remote supervision and distance education.
Adding the training program to the recruitment package enabled Mallacoota to find a new doctor who has been with us for three years now. Our doctor was the first of 14 who has been recruited to 18 of Australia’s hardest to fill locations, including six remote Aboriginal Medical Services.
The RVTS targeted-recruitment model has brought a more stable workforce and enhanced continuity of care to the participating communities, as well as providing career progression to specialist qualifications for the recruited doctors. There have also been numerous spin-off effects for the community which have enabled Mallacoota to expand both facilities and services.
Results from the pilot have revealed that the linking of high-quality vocational training to a specific remote location is an effective strategy to recruit and retain doctors to rural, remote and First Nations communities with high medical workforce need. The strategy has been most effective in locations such as Mallacoota where on-ground community-driven support fosters collaboration between partnering organisations.
Encouraged by these initial findings, the Australian Government is now providing additional salary support funding to enhance the market competitiveness and business viability of participating practices.
The story of what happened in Mallacoota, and how this led to our facilities and services playing an integral role in the survival of the community during the bushfires, is an example of how close community involvement with the medical system can lead to positive outcomes.
Lessons have been learned and challenges remain but, as a remote community, we have become more acutely aware of the substantial gaps that still exist within the health system and the further opportunities that exist for these to be resolved.
Beverley Glass
Beverley Glass, after being awarded her Bachelor of Pharmacy degree, chose to complete her internship in rural community and hospital practice, and thereafter held various practice, industry and academic positions. She is currently the Professor of Pharmacy in the College of Medicine and Dentistry at James Cook University (JCU) in Townsville. She teaches across a broad range of pharmacy areas, including rural and remote practice, and currently has over 25 honours and postgraduate students in her research program. Together with Dr Selina Taylor from the Centre for Rural and Remote Health in Mount Isa, she supervised the first professional honours rural project at JCU, entitled ‘Bridging Allied Health Professional Roles to Improve Patient Outcomes in Rural and Remote Australia: A Descriptive Qualitative Study’, recently published (2022). Beverley has always been committed to improving health outcomes for rural populations and has been fortunate to share this passion with Selina. This collaboration, together with Dr Alice Cairns, has resulted in 16 publications in the past five years. Together they are continuing to explore opportunities for pharmacists to work to their full scope of practice, collaboratively with other health professionals, to address the lack of access to health services and improve health outcomes for rural communities.
LISTEN UP: a rural community-pharmacy-based intervention
There are 1.3 million Australians affected by ear disease, resulting in preventable hearing loss and communicative ability. Ear disease is very common in rural communities where rural community pharmacists are well-placed to provide improved ear health care to people who are unable to easily access a general practitioner (GP).
The Locally Integrated Screening and Testing Ear and Aural Program (LISTEN UP) has been developed to apply an ear health intervention to the rural community pharmacy setting in Queensland, Australia, to improve management of ear disease. The aims are to evaluate:
- the feasibility, potential effectiveness and acceptability of a community-pharmacy-based intervention for ear health
- the use of otoscopy and tympanometry by pharmacists in managing ear complaints in community pharmacy
- the extended role of rural pharmacists in managing ear complaints, with the potential to expand nationally to improve minor ailment management in rural communities.
A study protocol has been designed and developed to conduct a longitudinal pre- and post-test study of a community-pharmacy-based intervention with a single cohort of up to 200 patients from two rural community pharmacies. The intervention will initially be piloted for six weeks, followed by a 12-month impact study. Patients aged >6 months presenting to the participating pharmacies with an ear complaint will be invited to participate. Pharmacists will be trained to conduct an examination including a brief history, hearing screening, otoscopy and tympanometry assessments. Patients will be referred to a GP if required, according to the study protocol, with same-day or next-day appointments available. At completion of the examination, patients will complete a satisfaction survey and receive a follow-up phone call at seven days to explore outcomes including prescribed medications and referrals. Pharmacists and GPs will complete pre- and post- intervention interviews. Patient, pharmacist and GP data will be analysed using descriptive statistics and thematic analysis for the qualitative data.
This presentation will describe the study protocol and demonstrate the implementation of a screening and referring ear health intervention in rural community pharmacy. Feasibility, potential effectiveness and acceptability of the intervention will be assessed.
Kristen Glenister
Dr Kristen Glenister is a senior research fellow at the University of Melbourne Department of Rural Health, based in Wangaratta in north-east Victoria. Her research involves chronic ill health among rural people. Her research interests include skin cancer, chronic obstructive pulmonary disease, diabetes, obesity and access to health care. This project is a collaborative project and Dr Glenister acknowledges all of the key stakeholders who have given generously of their time and wisdom.
A place-based, community-driven, nurse-led skin cancer care model in rural Victoria
Introduction: Rural residents face high rates of skin cancers and barriers to skin cancer care, including geographical distance, extended waiting times for service access and higher financial burdens. These issues can contribute to late diagnosis and poorer outcomes among rural patients.
A convergence of high consumer demand for skin cancer screening, long-term health workforce shortages and a group of passionate individuals led to a place-based, nurse-led, skin cancer care initiative in rural western Victoria. This study was undertaken to describe the elements of the initiative and map changes over time, from start-up to implementation and service delivery over three years, using a program logic model.
Methods: A longitudinal descriptive study, grounded in thematic approaches, is being employed to document elements of the skin cancer care initiative over time. Health service executive management, and clinical and ancillary staff, were invited to participate in interviews during the start-up phase of the initiative. Transcripts were thematically analysed independently by two researchers before comparison and refinement of themes. A program logic model was developed to organise themes into contextual elements, inputs, activities and anticipated outcomes, and will be used as a visual tool during discussions with key stakeholders. This program logic model will be refined during the implementation phase and again after three years of service delivery.
Findings: The skin cancer screening and care initiative is currently at the start-up phase. Seven interviews have been completed. Themes were mapped to the program logic model according to contextual elements (rural locale, health workforce shortages, historical late skin cancer diagnosis), key inputs (flexible and stable funding, systems support including referral pathways and clinical equipment, and human resources including appropriate nurse training and leadership) and activities (health promotion, local service delivery, treatment pathways). The anticipated outcomes identified include skin cancer care delivered locally, timely access, career development for nurses and, ultimately, decreased skin cancer burden.
Helen Goodwin
Mrs Helen Goodwin chose midwifery as a pathway to add to her nursing qualification and equip her to travel and work, and that’s what her career has done for her. She has practiced midwifery in the United Kingdom, Australia and Canada; in hospitals and private practice; and in metropolitan and rural environments.
Helen has worked in clinical practice in all areas of midwifery and in neonatal intensive care, as well as in clinical management and, most recently, in midwifery education.
Helen loves to empower women to make the choices that work best for them and their families, and support them through one of the most significant times of their lives. The highlight of her career was in remote Canada where the closest specialist centre was a three-hour retrieval flight away and she worked towards her private practice licence.
These days, Helen is working to build on the midwifery capacity in rural areas of Queensland by encouraging undergraduate midwives to take a rural placement opportunity. She supports them through Southern Queensland Rural Health while they learn and develop a love for rural practice.
Using virtual reality as an innovative approach to imminent birth rural education
Background and aims: Women in rural and remote areas may present to a hospital without a designated maternity service when birth is imminent. The Queensland Health Imminent Birth program for non-midwifery health professionals provides online theoretical education and a face-to-face workshop with simulation scenarios. Virtual reality offers an innovative way to deliver simulated learning experiences, bridging the issues of distance and timely attendance at face-to-face workshops. This pilot randomised controlled trial (RCT) aimed to examine the feasibility and effectiveness of an immersive virtual reality (IVR) simulation as an alternative to the Imminent Birth program’s face-to-face simulation workshop.
Methods: Twenty-three undergraduate health students were recruited to participate in the pilot RCT. All students were first invited to review and complete the online theoretical modules from the Queensland Health Imminent Birth program, after which they were randomly allocated to participate in either the existing face-to-face simulation (N=12) or an IVR simulation of the same scenario (N=11). Measures of knowledge retention, clinical reasoning and self-reported confidence in clinical practice were completed at three time points: prior to provision of theoretical modules, after completion of simulations and at two-week follow-up. The System Usability Scale (SUS) was also administered to the intervention group immediately following the completion of the IVR simulation to evaluate the usability and acceptability of the IVR equipment.
Results: Knowledge and clinical reasoning increased significantly for both intervention and control groups immediately after simulations, and these improvements were retained at two-week follow-up. Confidence followed a similar pattern and, although a significant decrease was observed in confidence scores for both groups between post-test and two-week follow-up, scores continued to remain considerably higher than at pre-test. The mean SUS score of 70.7 (SD=10.1) indicated that the IVR simulation was rated as ‘good’ by participants.
Conclusions: Findings from this pilot RCT indicate that IVR simulation is equally effective to the established face-to-face simulation in the Queensland Health Imminent Birth program in producing improvements in knowledge, clinical reasoning and confidence in practice. As such, IVR technologies may present an innovative solution for bridging concerns of distance experienced by rural health professionals. Moreover, use of IVR simulations with the addition of augmented reality may be a viable means of improving access to other forms of continuing professional development for health professionals practicing in rural and remote communities.
Heidi Gray
Heidi Gray has a long-standing interest in Indigenous and remote education, health and affairs. Heidi recently completed a Bachelor of Social Science (Psychology) Honours. The focus of her research was on the co-design of an evaluation framework for the Bathurst Indigenous Chronic Disease Clinic. Heidi is a trained primary teacher, with a large amount of her study and teaching focus being on working with Indigenous students and facilitating all students to learn about Indigenous cultures. Heidi is also a mother of three children, whom she currently homeschools.
Co-designing an evaluation framework for Marathon Health's Bathurst Indigenous Chronic Disease Clinic
Background and aims: Indigenous people experience mortality at younger age than non-Indigenous Australians, largely due to chronic disease. The National Agreement on Closing the Gap seeks to overcome the entrenched inequality faced by many Aboriginal and Torres Strait Islander people so that their life outcomes are equal to all Australians. One initiative is the Medical Outreach Indigenous Chronic Disease Program (MOICDP). This program seeks to improve access to health services for Aboriginal and Torres Strait Islander people living with chronic disease.
The Marathon Health Indigenous Chronic Disease (ICD) Clinic in Bathurst provides multidisciplinary clinical services focused on diabetes, cancer and cardiovascular disease. This clinic regularly engages with ~200 people, however no formal evaluation has been implemented. The aim of this study was to commence the co-designed development of an evaluation framework for this clinic, by consulting key stakeholders to identify the variables, measures and the methods for collecting that information, and collate this for use in future evaluations and service design activities.
Method: A qualitative design was utilised. Interviews were conducted with Bathurst ICD Clinic staff members, service managers and representatives from the funding body (NSW Rural Doctors Network). Research participants were made aware of the process of developing the evaluation framework for the ICD Clinic and completed a semi-structured interview with the researcher. Participants’ interviews were recorded and transcribed. A thematic analysis was undertaken following Braun and Clarke’s (2006) six steps.
Results: Themes that emerged from the data included an extensive range of information that participants believed should be considered in the development of an evaluation framework for this ICD Clinic. This information included an extensive number of variables that fitted well with the program logic model (inputs, activities, outputs, outcomes and impact) and with domains of key frameworks, including the Ngaa-bi-nya evaluation framework, the Chronic Care for Aboriginal People model of care and the value-based health care frameworks.
Conclusion: This study is an important first step towards the development and implementation of a co-designed evaluation framework for the Bathurst ICD Clinic. The results of this study provide a collation of the information that some of the key stakeholders in this service believe is important to be collected and informs the methods that will be used to do this in future evaluation activities. The results of this study will be combined with other similar research to understand the views of the clinic users, local community and Elders.
Melanie Green
Melanie Green is passionate about the health and wellbeing of community. Melanie has worked in rural health for the majority of her career, most recently as the Director of Operations at Mansfield District Hospital.
Melanie has completed a Bachelor of Science (Speech Pathology), La Trobe University, 1996; Master of Health and Human Services Management, Deakin University, 2014, majoring in Public Health and Community Engagement; Diploma of Risk Management and Business Continuity, 2015; and Melbourne Business School Executive Leadership Program, 2018.
Melanie enjoys the challenge of bringing people – teams, stakeholders and community – together to achieve things that are new, innovative and enabling. Devising a direction and structure around the bigger picture, working to a plan and then tracking progress, are all important to Melanie. Melanie finds it most satisfying when she is delivering efficient and creative outcomes built on strong relationships and advocacy efforts. Two of the greatest achievements Melanie has been involved in in health care are being presented at this conference: Mansfield Respond, a community-led response to tackling obesity, and Mansfield Restart, a community-led response to drug and alcohol rehabilitation.
Mansfield Restart: a community-led approach to drug and alcohol rehabilitation
Background: Drug issues can no longer be understood as big city problems. Drug use and related consequences impact all communities across Australia, including rural areas, while much of the capacity to address the issue is placed in the major population centres. Furthermore, there is a notable lack of locally tailored responses.
Mansfield Restart is a unique community-led drug rehabilitation intervention. It differs from existing approaches due to a high level of community engagement, evidenced by the diverse membership of the Community Steering Committee. Restart aims to reduce drug use and the effects of drug use and addiction on individuals, their families, friends and the broader community. The program operates from Mansfield District Hospital. Restart is delivered by a Registered Nurse Program Coordinator, and guided by key community stakeholders including GPs, local government, lawyers and police. Restart tackles the problem of drug use through multiple strategies including case management, treatment, rehabilitation, as well as prevention, and offers wraparound care. Restart has been evaluated through the use of program and survey data, and interviews with clients and key informants. This presentation explains the unique nature of Restart and reports on the evaluation.
Method: Integrated referral pathways, both into and out of the program, offers clients wraparound, holistic and person-centred treatment. An important and notable component of the extensive referral system is the multidisciplinary approach offered to clients. A crucial aspect of Restart is interprofessional collaboration, whereby professionals from distinct disciplines communicate and work effectively for the best patient outcome. Local medical, psychosocial, legal and law enforcement systems have come together, reflecting the many domains of life affected by drug problems. Individuals are referred into the program primarily from the community and from various medical pathways. Legal and law enforcement referrals also occur.
Results: During the three-year trial a total of 159 people contacted Restart and 107 people engaged by attending appointments. Alcohol, methamphetamine and cannabis are the main drugs used by Restart clients. Most clients have been classified as high-risk and complex. Of the clients who engaged with Restart, 17 per cent have maintained abstinence and fully recovered, while 44 per cent have indicated all or some of their goals have been achieved.
Conclusion: Restart has made significant impacts to our community, which emphasises the importance of locally tailored responses to addressing drug use.
‘The support I received was monumental and life-changing. When I was at my lowest point, this service was introduced and provided so much help.’
RESPONDing to children’s health in Mansfield: systems thinking enhances health promotion efficiencies
Background: Multiple international experts have called for the application of systems approaches to the prevention of complex problems. One such current project is Reflexive Evidence and Systems Interventions to Prevent Obesity and Non-Communicable Disease (RESPOND). RESPOND is an NHMRC-funded project across 10 local government areas in north-east Victoria. Mansfield is one of these areas.
The rural town of Mansfield has a population of 8,584, with 970 (aged 0–9 years) children. Data collected in 2019, from 190 children in Years 2, 4 and 6 showed 21 per cent of boys and 24.5 per cent of girls were overweight or obese, and only 11 per cent of boys and 12 per cent of girls met their daily vegetable intake requirements.
This data mobilised the local community to explore what was working well and to identify additional opportunities to improve children’s health. This abstract presents a case study of this systems-thinking approach to children’s health in Mansfield.
Methods: Local facilitators were trained in the use of community-based system dynamics and led community workshops in late 2019 to construct a causal loop diagram (CLD) that explored the question: ‘What helps and what discourages our children to eat healthily and be physically active?’. From this CLD, community stakeholders identified factors and connections impacting the issue, and prioritised feasible solutions. Three community working groups were established: Social Connection, Food and Nutrition, and Physical Activity.
Results: To champion a systems approach to prevention, resources were mobilised to appoint a local champion at 0.2FTE to facilitate community-led change. An overarching finding of this work demonstrated enhanced efficiencies within the health promotion team through the reinvention of work models that facilitate rather than operationalise change. One initiative from each of the three working groups is presented.
The Social Connection working group co-designed the ‘Mansfield Resilience Project’ which supports local parents across a multitude of topics (on request) via an online education platform. The Food and Nutrition working group assisted the poor access to fresh fruit and vegetables through the establishment of the ‘Mansfield Fresh Food Drive’. To increase incidental activity, the Physical Activity working group co-designed an innovative ‘Active Footpath Project’ that adds value to existing infrastructure.
Discussion: Working with community stakeholders in the design and implementation of change efforts enhances local buy-in and sustainability. Importantly the experience of Mansfield has seen efficiency gains in resourcing health promotion that led to unique community-driven prevention programs.
Heath Greville
Heath Greville is a research fellow at the Western Australian Centre for Rural Health (WACRH). Her background is in Aboriginal adult education, communicable disease policy and planning, and mental health professional education. Prior to joining WACRH, Heath spent four years in China setting up a charity to improve educational outcomes for children in rural and remote villages. She is currently working on the primary prevention of family and domestic violence through an intervention research project in Geraldton, 450 kilometres north of Perth.
Preventing family violence in rural areas: what role can online learning play?
Background: Family and domestic violence (FDV) is a serious public health issue with insidious physical, mental health, behavioural and social consequences; sadly, FDV is more prevalent in rural areas. The rate of assault by a family member in the Mid West and Gascoyne region from July 2019 to June 2020 was 36 per cent higher than that for regional Western Australia (WA) and more than twice the state average.
The National Plan to Prevent Violence Against Women and their Children recommends primary prevention initiatives that increase gender equality, with locally relevant interventions across all levels of the social ecology: individual and relationships; organisation and community; system and institutional; and societal.
Intervention research by the WA Centre for Rural Health (WACRH) is supporting Community, Respect and Equality (CRE), a plan for primary prevention of FDV in the City of Greater Geraldton. Speaking Out Against Disrespect is online bystander training that aims to build individuals’ skills and confidence to intervene in situations that demean or dismiss women by challenging sexist language and behaviour.
Findings: Between December 2020 and August 2021, the training was accessed by 600 individuals, predominantly females (78%) aged 18–39 years (77%). Of these, 62 per cent cent were students on placement in rural areas who completed the training entirely of their own volition. The remainder reported working for an organisation in or outside of the CRE. Immediately following the online training, shifts in skills were reported in:
- understanding of the link between disrespect, sexism and family violence (shift from 62% prior to 96% reporting good/very good understanding after the training)
- knowledge of appropriate things to do and say to challenge sexism and disrespect (shift from 45% prior to 94% reporting good/very good knowledge after the training)
- knowing how to take action when witnessing inappropriate, disrespectful and discriminatory behaviour (shift from 44% prior to 92% reporting good/very good skills after the training).
The presentation will report on a six-month follow-up survey to investigate:
- actual bystander action taken following the training (if any)
- reasons for taking or not taking action when witness to disrespect
- participants’ perceptions of community attitudes to bystander action
- differences between members of participating CRE organisations who completed the training and others who completed the training.
Kalinda Griffiths
Dr Kalinda Griffiths is a Yawuru woman and epidemiologist who commenced her academic career as a trainee at Menzies ($12 million+ funding; 20+ publications). She is an early-career researcher who is dedicated to building the capabilities of the next generation.
The Menzies-Ramaciotti Centre: building the biomedical workforce of regional and remote Australia
There is a need to support the development of and build the biomedical workforce capacity in regional and remote Australia. The Ramaciotti Regional and Remote Health Sciences Training Centre (Menzies-Ramaciotti Centre) was established to develop a sustainable, local and Aboriginal and Torres Strait Islander biomedical and health sciences workforce in the Northern Territory. The Centre facilitates biomedical and health sciences career progression for regional and remote youth. It was launched in February 2021 and has and is currently delivering a range of training programs to 35 youth and students, 25 of whom identify as Aboriginal and/or Torres Strait Islander. The Centre is uniquely positioned and co-led by Indigenous and non-Indigenous staff within the research sector in order to build innovative approaches to the ways in which training in delivered. This has included the advancement of a range of partnerships with a number of schools and other workforce providers across the Top End. It has centred the voices of youth and students in the governance of the Centre to support innovation and to identify what is necessary for success. This has also included adaptive education and training models to ensure the delivery of training services for those school leavers and students that may ordinarily experience additional barriers to these services. Here the co-leads report on the Menzies-Ramaciotti Centre, its current governance processes and provide some insights to the enablers of the Centre’s success to date.