This story comes from Adrian, a podiatrist working in rural and remote Queensland. Adrian’s story reinforces the need for podiatrists to be included as part of the multidisciplinary team. But their role is not well understood. They diagnose, treat and prevent foot abnormalities and provide education and support. With the high rates of type 2 diabetes and cardiovascular disease in rural and remote communities having a podiatrist as part of the health care team is essential. However, there are not enough of them.
As a profession, podiatry services are few and far between with significant gaps in the numbers of services that can be provided in rural and remote areas. For example, there are 16/ 100,000 in major cities but only 6/ 100,000 in remote and Very remote areas. Podiatrists play an important role in looking after the health of people’s feet. However, as Adrian points out getting the community to understand how podiatrists can help with their health and wellbeing is one of the ongoing challenges particularly when working in area where financial hardship is a major factor.
A typical day for a visit to a rural community of Kilkivan (around 200 kilometres North West of Brisbane) starts with a $2 coffee for the 2.5 hours commute (each way). The Podiatry clinic at Kilkivan is always busy with clients waiting before I have set up. The old forestry building turned into a council run clinical space is a hub when services visit. The services include: General practitioner, Nurse Practitioner, Physiotherapist and Counselor. The services are usually fortnightly, advocated by the then Sunshine Coast Medicare Local and funded through Check Up Rural Health Outreach Fund (since 2012).
Podiatrists provide all sorts of services, from screening young children, making orthoses, helping clients with wounds to general foot care and undertaking minor surgical procedures. This therefore provides a unique challenge, in that you need to be prepared and have all the equipment, dressing and lotions and potions at hand to provide the care. It therefore requires bringing many resources to the clinic to aid in the care of whatever walks through the door. I believe, just because you are working in a rural setting, your level of care should not vary from a metropolitan private clinic.
Another more difficult factor is to be able to engage (on an ongoing basis) clients who are either disadvantaged, suffering from illness, mentally unwell or simply cannot understand how we can help. In times where rural areas are suffering both from the abovementioned issues and with lack of finances, therefore not being able to afford things like shoes, orthoses, dressing or even petrol to run into the clinic.
I deal with these challenges in different ways, and one way I feel the service is working, is that after almost 7 years – the patient numbers and community engagement has increased. My philosophy is that there is no such thing as “a non-compliant patient,” every client has their unique issues effecting their health. Having a small idea of what that may be – helps you engage and tailor your services accordingly. For example, having leeway with appointment times, with clients with sickness and attending their homes, working with family members of the clients and sometimes listening and engaging with a client’s concern whatever it may be.
Financial hardship is a major factor in health care in the region. I therefore provide shoes and orthoses at a fraction of the cost and utilize third party funding streams where I can. It is not a money-making exercise; we are paid to work in the region – so there is not a need to be greedy!
I love rural health, because your clients become friends, you feel a part of the community. The other health practitioners you work with become your allies to work for the common goal. I find rural practitioners can work within their scope and challenge their skills every day, but most importantly be able to be a voice for clients.