Ellen is a dietitian practicing in Dubbo, a city in the Orana Region in country New South Wales. In her story, Ellen shares the challenges she faces in her work, mainly isolation, the vast distances travelled to reach clients, low distribution of staff that is disproportionate to need, and a lack of peer support. Like most professionals working in rural and remote areas, Ellen has adopted mechanisms to cope with these challenges, and loves working in rural Australia.

Ellen’s story:

Our dietitians travel vast distances to see clients across country NSW. They are often the only dietitians working within these communities—providing a range of services associated with chronic disease management and prevention, childhood nutrition, weight gain/loss, nutrition in the elderly and more. 

On a typical day I work across nine sites around Dubbo—this means I travel anywhere from half an hour to two hours to deliver three clinics a week.

Travel is big part of my day but after that it’s providing dietetic consults through GP clinics or multi-service clinics.

In as far as the services I provide, as the only dietitian in these regions, I have to be flexible with the services I provide. That means I need to know a lot about different areas of dietetics rather than have one speciality.

Essentially the core of what I do is working with people who have a chronic disease, type 2 diabetes, cardiovascular problems, high cholesterol, bowel problems, cancer and autoimmune diseases.
I don’t just see adults, I also provide support to children—particularly children with concerns such as coeliac disease, or who may not be growing properly.

The biggest challenge I face is coping with personal and professional isolation. As the only dietitian in these locations, and in our office, I don’t have anyone I can bounce questions off. If I want clinical advice for tricky clients I have to call contacts further afield, and I’m always cautious that I’m not asking too many questions too often.

It’s particularly challenging being first year out of university and not having that clinical guidance.

Coping with isolation will always be difficult, especially living in rural and remote areas, however I do try and connect as much as can to senior clinicians and staff members.

I also think it’s really important to stay up-to-date with the most recent research, studies and practices—particularly as I do see clients with such a broad spectrum of concerns.

More support and senior clinical guidance in my workplace would be fantastic, but it is limited as we are a not-for-profit charity heavily reliant on funding. It would be great if people wanted to work out in our country communities more, not just the cities, so we can build that community of health professionals.

I love the people in the rural areas where I work. There’s something about people in country communities—they’re genuine, kind and friendly people. I love all the stories they tell me and how appreciative they are when I come to see them.

Allied health professionals face particular challenges in their work. The types of diseases they deal with from day to day: chronic disease, type 2 diabetes, cardiovascular problems, high cholesterol, bowel problems, cancer and autoimmune diseases are all major health challenges in rural and remote areas. Responding to these challenges is a huge task for professionals who quite often, as already noted, lack the necessary supports to enable them to do their work to best effect. One way of addressing workforce shortages, Ellen suggests, would be to interest people to work in country communities. Attracting the allied health workforce, and particularly dieticians to work in rural and remote communities, is an important issue that needs serious consideration.   

Acknowledgements

The National Rural Health Alliance wishes to acknowledge Marathon Health for providing this story.