Rural Road to Health

A journey down the rural road to health. This podcast explores rural health topics through conversations with academics, clinicians, researchers, and people that live and work in rural areas.

Profs Sarah & Roger Strasser - Adventures in Rural Health Education & Research 06/20/2025

Profs Sarah & Roger Strasser - Adventures in Rural Health Education & Research Prof Sarah Strasser and Prof Roger Strasser, a trailblazing couple in the world of rural health, rural health research and rural medical education. Episode summary: 01.15 Sarah and Roger share how they became interested in rural health and some key highlights from their careers 15.30 What did they find most rewarding about living and working in rural areas and what was challenging? 20.50 How did they balance all their different roles with their family life? 29.30 What have been the most important research projects that they have worked on? 51.30 What is NOSM and what makes it different from other medical schools? 59.45 What were the enablers for the development of NOSM? 1:05.00 What has it been like to be a woman and trailblazer in the rural health space over time? 1:11.15 What do they see as being the research focus in rural health in the next 5 to 10 years? Key Messages: They have lived and worked in different countries and in different rural and remote communities. They both share a passion for rural communities and rural health. In 1991 the first National Rural Health Conference inspired a lot of activity around rural health in Australia. Monash University developed rural training pathways and the Monash School of Rural Health. Roger became the first Professor of Rural Health in Australia. Roger acted as the Founding Dean of the Northern Ontario School of Medicine in Canada for 17 years. This is a multi-site rural based full medical school. Sarah started her academic journey in Canada by teaching nurses about whole person medicine. She then became regional director of general practice training in Australia and then became the national director of rural health and covered Indigenous health. Sarah later became dean of Health Sciences at the University of Otago New Zealand. Most enjoyed: The sense of space and being part of the community. Having a very privileged role which lets you get to know the deep issues within the community. Using that privilege in an appropriate way and making a difference for the better. Relationships with the people and the community. Community connectedness. Challenges: Lack of child care that works for you. Lack of resources. Realizing how frustrating it is when things that you need on a daily basis run out or are not working, this can be a quick way to get burnout. Balancing their careers, different professional roles, and raising a family was challenging. Work-life balance gives the impression that work is not part of life. Roger prefers the concepts of work-style life-style mix. Research and teaching are integral to clinical practice. In the daily interaction with patients there are often questions that come up, occasionally there is not an answer in the literature or when asking a colleague. This can be part of a new research question to pursue. It is all woven together. It has been wonderful to see how things have changed over time. On one hand some things seem to stay the same, on the other side everything has changed. Over the last couple of years has been going to conferences that are full of people she does not know. Two threads of research. One was a series of studies asking people in rural and remote communities about their needs. They have a security need, they need to feel that there is a safety net. They first need a doctor and a hospital. Then looking at the sustainability of rural and remote services - 22 in depth case studies. Found that the ones that were doing well had active community participation in the running of the health service. Looked at issues of recruitment and retention of healthcare professionals. Explored contributing to factors of success and developed a rural workforce stability framework with 5 country partners. Active community participation again came up as a strong factor for success. The second thead was education and training for rural practice. Recognizing that there is a better chance of medical graduates going into rural practice with early exposure to rural contexts. Rural upbringing, positive rural clinical experiences and postgraduate training that prepares clinicians for rural practice are the three factors that have been shown to be most important. Immersive community engaged education. Seeking out the disconnects and trying to prove alternative ways of doing things. Don’t accept things as they are, go and investigate and find out what needs to be done. Communication and dissemination is an important part of research, share what you find with the relevant people. Encourage community engagement and recognize the importance of patients as teachers. Rural practitioners are naturally effective teachers. Doctors more generally after time in practice through their interaction with patients develop a lot of skill in teaching. Importance of having contracts - doctors and the community knew how long they would be there and gave them an opportunity to renegotiate their position. WHO has published updated policy guidelines in 2021 for the recruitment and retention of the rural health workforce. Their research has been adapted for this document. NOSM came into existence because the community recognized that they needed their own medical school to have a sustainable health workforce. It is the first medical school in Canada with a social accountability mandate. This is about improving the health of the people and communities of Northern Ontario. NOSM has a full immersive learning experience based in local communities. All students have a year long integrated longitudinal clerkship, living and learning in one community. 77% of NOSM graduates are in general practice, 14% are in other general specialties like pediatrics or general surgery - a very different outcome to other medical schools in Canada. Politics is a large part of establishing a medical school. NOSM has support from the Mayors of the 5 main municipalities, government support and community support. Everything aligned to enable it to happen. Say “Yes And” to opportunities, then add some of your own suggestions or boundaries. If you find that it does not work, let it go. Be aware of the existing rural health research and undertake research which builds and contributes to that. Future research can enable connection of rural communities across countries. It should be undertaken in rural communities, by rural communities and for rural communities. Use frameworks that have already been established so that the research can add value to and build on what has already been done. The Partnership Pentagram or Partnership Pentagram Plus is an example of a possible framework which could be used in this way. Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/36901750

Prof Bill Ventres - Healthcare on the Margins & Storylines of Family Medicine 06/10/2025

Prof Bill Ventres - Healthcare on the Margins & Storylines of Family Medicine Prof Bill Ventres is a family physician, medical anthropologist and (recentrly retired) Distinguished Chair of Rural Family Medicine at the University of Arkansas in the USA. Episode Summary: 1.30 Bill tells us about his professional background and how he became interested in rural health 04.30 What made him choose to live in El Salvador? 09.30 What has he most enjoyed about living and working in rural areas? What did he find most challenging? 13.45 What is Arkansas like, what is the context there like? 19.00 Storylines of Family Medicine - why did he decide to do this project? 29.45 What are some insights about practicing in rural and remote contexts? 33.05 What insights has he had in his work on rural workforce development? 36.20 What were the main challenges for building a rural workforce? 38.55 What are some possible solutions to rural workforce challenges? 43.30 How are rural and urban practice similar and different? 49.15 What would his top advice be to policy makers? 51.10 Top three tips for students and early career professionals thinking about a rural career Key Messages: He has spent his career working with people who find themselves on the margins of society. He started his work in urban underserved settings. After spending some time in El Salvador he returned to Arkansas and started working in rural areas. He is now a student of Latin American Philosophy while living in El Salvador. Many people in rural and underserved areas feel left out, many people in rural and underserved areas feel on the margins of a greater society, and that the medical system does not really attend to their needs. He most enjoyed listening to the stories his patients told and hearing about the experiences that people had. That is one of the wonderful things about being in a small practice, one really gets to know the pulse of all the people in the community. The biggest challenge were the not so happy stories about access. No one wants to be number one in maternal mortality, it is a problem of rural poverty and exacerbated by a long history of exclusion and structural racism. Arkansas is economically the third poorest state in the USA. There is one larger city, Little Rock, famous for what happened in 1957 when the president sent troops so that 9 teenage black children could attend the local white public school and that was the beginning of desegregation. The rest of the state is rural. Walmart is based in northwest Arkansas, so that part of the state has seen a revival. There is huge income inequality. - this is a published series of papers that shares reflections on family medicine from residents and family physicians. For caring for a community of patients the medical model does not work well for the kind of things that we encounter in family medicine. There is a transcendental nature to the work that we do in family medicine. The biggest cultural barrier is between medicine and real people. He was interested in hearing what motivated other people (family doctors), they told their stories of what was the one tenant of practice that motivated them. He asked 136 doctors to share their story in the form of short essays. Family medicine means attending to the needs of the patient whatever they may be in the context at hand. Modern rural medicine uses up to date knowledge transmitted to rural communities, rather than the traditional model which sends rural patients to urban centres. The presence of a physician and the presence of a hospital helps to support small rural communities. The future is in the hands of young family physicians. Find other practitioners who are like you and work together to speak up, advocate and receive support. We all need support, and in rural areas sometimes that is hard to come by. We need to find people who hold similar values and share a similar vision of the importance of the work we do. Challenges are financial, attitudinal, geographical, and unanticipated consequences of AI in medicine. Embed yourself in a community, find a community and do that work. Be open to a different way of seeing that work than what you learned in your medical training. We should be training people to be socially accountable to their community. Understanding the needs of rural communities form the biomedical point of view and the social community point of view. It is important to find people and institutions that are helpful. Finding someone whose ideas can resonate with yours. Some international organizations such as WONCA or TUFT and Deep End Project. Linking with organizations and groups like that to become a collective course. Burnout is about not having true meaning behind the work that you do. Have students in your office so that you can pass things on. People living in the interstitium of society are similar in rural and urban areas. Rural health is being disappeared in the US and funding is being cut off at present - stay the course. If you don’t feel comfortable advocating, find someone who is. Medical education is stuck in a model that isn’t working for rural health, let people know, show the work of rural medicine to new generations of physicians. There is a richness to the work and it can be incredible Be in it for the long haul. I am I and my circumstances. Grow that self over time. The work I do is worthy and my circumstances, the rural circumstances that I chose helps to engage me, and I reciprocally engage the community. Bring that to patients. Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/36720430

Heather Sherriffs & Dan Martin - ScotGEM & Rural Training on the Orkney Islands 05/30/2025

Heather Sherriffs & Dan Martin - ScotGEM & Rural Training on the Orkney Islands Heather Sherriffs & Dan Martin are medical students on the ScotGEM training pathway. They share their experience of graduate entry medical training in Scotland, their placement on the Orkney Islands and how this is shaping their thoughts about their future careers. Episode summary: 01.15 Heather and Dan tell us a bit about their professional backgrounds and how they got interested in rural health 03.30 What have they found most rewarding about working in a rural setting? What has been most challenging? 06.45 What is ScotGEM? 09.30 What opportunities does ScotGEM give students? 12.30 How are hospital placements organized? 14.10 How is the course preparing them for working in a rural or remote setting? 16.30 What is Orkney like, the population, geography and care needs? 20.45 What has there experience been with weather and distance? 24.45 Who is part of the wider healthcare team on Orkney? 27.25 What does a standard GP day and week look like on Orkney? 30.30 What has surprised them about Orkney and primary care? 33.50 What are the two or three key learning point that they have gained from their placement in Orkney? 35.32 How has the experience changed their plans for their future career? 40.30 What is their advice to other postgrads who might be considering going into rural medicine? Key messages: Both Heather and Dan had completed different degrees before going into medicine, law and teaching. ScotGEM is a course to prepare students to become a general practitioner in rural and remote environments. It is a graduate entry degree. It is different to traditional courses as your lectures and placements are integrated, you see patients from day one and you have case based learning. The applied nature of the course really supports learning. They also have a longitudinal integrated clerkship in general practice which lasts 10 months. They have had a lot more one to one time with tutors and doctors at the hospital and in general practice, there is more exposure to clinical skills early on. There is more space to explore and try different things during your course. While on Orkney they spend one day a week at the local hospital during their GP longitudinal placement. Heather would be nervous to work in a rural or remote setting if she had never had a placement in that setting before. It is hard to imagine what the job entails if you have not seen it before. This course prepares you really well to work in a rural or remote setting. Dan says it is a certain skill set to be able to go out and stay in a rural or remote settings. Orkney is a set of islands off the northern coast of Scotland. There is a population of about 20000 people. There is an aging population with people needing quite a lot of social care. During COVID people returned to Orkney. The A&E on Orkney is GP lead and when the weather disrupts travel it can be challenging to manage more difficult emergencies. There are four permanent GP surgeries on Orkney and a small hospital in Kirkwall. The hospital has medicine, surgery, emergency and maternity. GPs to normal general practice but also have their specialist interests such as dermatology, mental health, palliative care or women's health. One of the GP surgeries specialize in diving medicine and have a hyperbaric chamber. There is a higher level of responsibility as a junior doctor, you might be the only doctor overnight running the medical and surgical department. The doctors say that they feel well supported. Just take every opportunity that you can get. If you are interested in something, turn up and ask questions. There is a lot that you can do to develop your clinical skills. It has helped them build their resilience. Dan is now considering a career in general practice and public health in a rural and remote context, he has become more interested in this following his placement in Orkney. Heather has always been interested in working somewhere remote or rural but the past year has solidified that interest and given her confidence to take a job in a rural or remote context. Applying to medicine later in life and having some life experience can be a bit of a super power going into medical training. Interpersonal skills and empathy are building blocks that you can use. Contact Heather: Contact Dan: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/36717770

Dr Iva Petricusic - Rural Health in Croatia 05/20/2025

Dr Iva Petricusic - Rural Health in Croatia is a rural family doctor form Croatia. She is the vice chair of the young doctor committee of the Croatian Medical Chamber and a coordinating member of EUROPREV. Episode summary: 01.15 Iva tells us about her professional background and how she became interested in rural health 03.15 What does she most enjoy about living and working in a rural area? What is most challenging? 07.45 What are the characteristics of the place and community where she works? 13.00 How is primary care organized in Croatia? 17.15 How is family medicine training organized in Croatia? 20.45 What are some of the challenges facing rural communities in Croatia? 26.10 What has changed to improve recruitment and retention into family medicine? 33.00 What would be needed to improve recruitment and retention in Croatia and on the islands? 38.45 What are the challenges faced by doctors thinking about going into rural careers in the European context? Key messages: She would recommend that everyone try living in a rural area to understand the context. Rural areas have a slower pace of living and as a doctor you have multiple roles in the community. As a doctor in the village you are involved with many parts of the patient's life. This can be challenging as you can feel like you are more responsible for them and their health. She often finds herself in situations for which she was not prepared for during her medical training or residency. There are three general practitioners and two pharmacies serving a population of about 5000 people. They also provide care to several nursing homes. Outside of her village there are many places that have been without a doctor for years, they have not had proper medical care, sometimes doctors would be there for a few hours every day or every other day. Young doctors are often placed in such communities and this is very demanding. Local community supported her in getting the supplies that she needed to work but was not available when she arrived. It is difficult to find healthcare workers and attract them to the local region. Not many young doctors decide to stay. Many GPs are retiring. There are 2173 doctors in family medicine in Croatia and the average age is 52 years, of which 858 of those are above the age of 60. It is difficult to find replacements. Slavonia was affected by the war. There are areas that have been abandoned and have difficulty maintaining even a nurse in their community. Croatia has primary care divided into three levels: family medicine, primary pediatrics and primary gynaecology, and it includes dentistry. Primary care is also divided into private and public sectors. However private is not really private, it means that the national insurance company directly has agreements with the doctors working there. In the public sector the national insurance provider has an agreement with the employer that doctors work with. Everyone works for the public sector, but they are paid differently and from the same source. After finishing medical school and internship in Croatia you can work as a GP, in the emergency department or as a prehospital doctor (with the ambulance service). It is suggested but not obligatory to have specialist training in family medicine. Around 1000 of the current family doctors have completed specialty training. The residency program lasts four years, 22 months are spent with a mentor in family medicine practice and 18 months in hospital rotations. There are no rural training pathways in family medicine residency. In undergraduate training there is a requirement to spend 1 week in rural practice. An aging population with multiple comorbidities and complex health needs is becoming more of a challenge. Poor transport infrastructure makes it very difficult for patients to attend secondary care appointments or attend diagnostic tests. Not all villages have an accessible pharmacy, sometimes this means having to organize the medication for a patient to be collected by a nurse, friend or family member who can travel 20km to the pharmacy. Certain tertiary care is only available in Zagreb, 300 km away. This can prolong the time between when a need is identified and a patient receives care. District nurses are important members of the team who can support patient care and share important information about what is happening with patients in the community. Most of the current residency programs in family medicine are funded by the European Union. At present there are about 300 residents in training in Croatia. This is still not enough to compensate for the colleagues that are expected to retire. More local municipalities are recruiting young doctors, such as Istra, they invested funds in this. Local municipalities are looking at how to attract doctors, they offer places in kindergarten for children (childcare is difficult in urban areas), free accommodation, and other privileges. Tourist areas are not attractive to doctors in Croatia due to the extra pressures during tourist season. The number of patients per doctor can grow to 5000 or 6000. Supporting specialist interests for GPs is seen as an attractive opportunity that could support rural practice in Croatia. Housing is a challenge in rural and island communities. Healthcare facilities need investment in equipment and facilities. Croatia has created a which provides up to date information on the health workforce. The data is updated daily. Family medicine is something that you either like or don’t like, it is different to other medical specialties. Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/36459700

Prof Bruce Chater - A Story of Rural Generalism 05/10/2025

Prof Bruce Chater - A Story of Rural Generalism Prof. Bruce Chater is a rural generalist, Head of the Mayne Academy of Rural and Remote Medicine Clinical Unit in Queensland, Australia, and the Chair of Rural WONCA. Episode summary: 01.15 Prof Chater tell us about his professional background and how he became interested in rural health 05.50 What has he most enjoyed about living and working in rural area and what has been challenging? 11.20 Prof Chater tells us how he has contributed to the development of rural practice and rural medical education in Queensland 16.40 What is it like to be in rural practice for 40 years and how do you step down and hand over well? 24.45 How has he maintained the enthusiasm to keep advocating, improving his practice, and teaching students? 31.00 How has he been involved in advocating for better healthcare for rural communities? 40.25 How was Rural WONCA established? 47.15 What have the key achievements been for Rural WONCA over the past 30 years? 51.05 Why should rural clinicians become part of Rural WONCA? 58.30 What are your top 3 tips for people thinking about a rural health career? 1:01.45 Looking to the future Key messages: Rural practice is a chance to have broad skills. I tell my students - Do you want to know more and more about less and less or do you want to spread your wings and be a generalist? When training the key part is that you go to a good place and that doctors are matched well to rural places. The best part about living rurally is the community. What you see is what you get in small communities. The community is genuine and you get to know the people. Continuity of care, comprehensive care and the capability that you can bring to that. You can do a lot in rural areas. Challenges: lack of local education opportunities for children, getting things across to urban bureaucrats - “geographical narcissism”, clinical challenges and “clinical courage”. Clinical courage - it is about having to step up and do the right thing for someone in your community and it might be about using a skill you have not used in a while. The key element of clinical courage is having a good network of other rural doctors to support you in those situations. Knowing that if you do not do something this person might die. Doctors were isolated and were not a force for good, they had to organize and get together. He was the founding convenor for rural doctors in Queensland and Australia. This led to the formation of the National Rural Health Alliance in Australia. Through the College of Rural and Remote Medicine worked on developing a curriculum for rural medicine. Set up a Statewide clinical network within the Health Department. Developed a model for funding rural hospitals that could be implemented in Australia. Currently also a Professor of Rural and Remote Medicine ensuring there are students in rural areas and making sure there is research about rural areas. Has recently retired and handed over his practice and local hospital to a new doctor - this was a test of the theory and practice he has been advocating for. It is important to have an exemplar practice, rural practice should not be somewhere where you are making a massive income, but you should be well remunerated. You should help people that need help. In Australia there is a mix of public and private practice, he has done a mixture of both and found that this has worked well. Those that can afford to pay for the service and those who can not pay have a good safety net. Be a solution not a problem to the health system. The key has been to get lots of students and young doctors into the practice. Do all the students come back, no, but it is about getting some of them to be inspired to consider rural practice. You can not be what you can not see. The doctor that has taken over his practice came out as a student and then as a registrar and finally said can I take over the practice. Rural generalists must provide general practice, in-patient medicine, emergency medicine, public health and some other special-skill for the community. It bans the boring. You have to protect the next generation. With the doctor that has taken over practice, he spent three years teaching the clinical side of the practice and another three years on how to interact with the health system, interact with management, and have a group of staff. It is important to not be on call all the time. He has looked after his community and they have looked after him. Burnout comes from complete overwork, but it also comes from not being able to express our humanity. They close the practice for half a day every week to talk about their difficult patients, everyone finds that very satisfying. It is important to make sure that the service is equitable across all areas. If you can provide good services then people will stay in rural areas. It is about trying to bring to policy makers the understanding that this is an investment, if they do it well they will have happy people, healthy people, and productive people in rural areas. You’ve got to be there to be heard. It was important to build a collegiate group that could advocate, then getting the rural communities on side and getting the politicians on side. Give the politician the problem, but also provide a solution to the bureaucrat. Then it is about thanking them for recognizing the solution. Recognized that this was going to be a long process. They needed to build an evidence base. It does not come quickly or easily. You need to be persistent and continue to be there. Rural WONCA has developed policies and declarations as well as the Rural Medical Education Guidebook to support rural clinicians. Rural WONCA was established in 1992 as a Working Party on Rural Practice. Top tips: Give it a go. If you don’t try it you will never understand it. Be prepared. You need to be prepared properly for rural practice. If you are not trained for it you will crash and burn. Find a place where you will be supported to learn. Email: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/36158135

Ashley Lambert - Rural Health in Medical Education: RHiME 04/30/2025

Ashley Lambert - Rural Health in Medical Education: RHiME Ashley Lambert is a medical student from the University of Swansea in Wales who is currently on the Rural Health in Medical Education track (RHiME). Episode summary: 01.05 Ashley tells us about her background how she became interested in rural health 02.33 What does she most enjoy about working in a rural area, what does she find most challenging? 08.40 What is RHiME at Swansea University? How is it different from the standard medical curriculum? 17.50 Do they have opportunities to connect with other professions? 19.00 How is she involved in wilderness medicine and does she see it as a part of rural health? 24.30 What has surprised her during her course? 27.45 What makes for a great student rural placement? 34.15 What does she hope her career will look like in the future? Key messages: The best thing about rural areas is the community and the feeling that everyone knows everyone, and the rapport that you have with patients. As a medical student she loves being in a rural area as there are more opportunities for hands-on experiences. However it can be difficult to see patients presenting at a much later stage of their illness. RHiME is the Rural Health in Medical Education track at Swansea University. This track offers rural placements and more of a focus on rural health as well as the undertaking the usual curriculum of medical school. Regular meetings and collaborations such as mountain and cave rescue, working with rural GPs and district nurses, working on social prescribing, talks about farming and opportunities for different placements in rural areas. Wilderness and Expedition Medicine Society has similar aims as RHiME, they encourage people to embrace the outdoors and rural life and to stay in rural Wales. They do a lot of activities, regular group hikes, bouldering, first aid courses, teach people how to tie knots, they also work with rural health doctors and mountain rescue. Wilderness and expedition medicine includes a lot of prehospital emergency care. They have medical teaching in the wild such as C-spine management, hypothermia management, splinting, search and rescue, and ultrasound in the field. The RHiME track has not made connections with other rural medical education programmes, but they would be interested in connecting with other students interested in rural health. The practice made her feel welcome, she was able to sit in with all of the practice staff and see the different way that they work with patients, it was useful to see what all of the different staff did as part of their role. Allowed her to take it at the pace she wanted to and asked her what she wanted to learn. She was given the opportunity to speak with the patient in her own room, make a diagnosis and management plan before discussing it with the GP. The feedback was then very useful for her learning. Swansea-Gambia Link is a project that she has been working on which will support student exchanges between the Gambia and Wales. Contact Ashley: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/35860000

Dr Jane George - Recruitment and Retention of Rural Allied Health Professionals 04/20/2025

Dr Jane George - Recruitment and Retention of Rural Allied Health Professionals is a health workforce consultant and academic from New Zealand, specialising in rural workforce and the Allied Health, Scientific, and Technical professions. Episode summary: 01.00 Jane introduces herself using a traditional way 03.10 Jane tells her about how she became interested in rural health 07.15 What does she find most enjoyable about rural areas and what she finds most challenging? 12.50 Why did she decide to focus her research on the rural health workforce and allied health professionals? 15.30 What kind of roles do allied health professionals hold? 18.15 Is there a good distribution of allied health professionals? 21.00 What challenges are facing the rural health workforce? 24.10 Do allied health professionals have access to rural based training or rural training pathways? 26.20 What has she learned through her research about attracting and retaining allied health professionals? 28.15 What factors were getting overlooked and why were they important? 31.34 Jane expands on the themes of her research 38.10 What are her top recommendations for local healthcare organizations and for national level policy? 46.15 What is she working on at the moment? Key Messages: The things she loves about being rural are also the most challenging things. Wide scope of practice and the can do attitude. We are never far from the people we serve. Endless opportunities for advocacy. Surrounded by inequity which provides motivation to improve what we do. Opportunities to challenge geographical narcissism. How do we get better at recruiting and retaining the workforce? This was the question she was searching for an answer for. She chose to focus on what matters to allied health professionals to identify what would best attract and retain them. Finding out what made rural work worthwhile. Allied health professions in rural areas can be pharmacist, physiotherapist, podiatrist, occupational therapists, medical laboratory scientist, radiology technicians, social workers and more. It can be difficult to know what the distribution of allied health professionals is across different regions. The government is working on monitoring this better. Service challenges and professional challenges. The amount of travel that is required, isolation of practice, reduced episodes of care available to stay current. Reduced access to professional development, and a constant need to be pushing back against urban narcissism. Social work is a great example of rural based training, as they have been providing distance training for over 10 years. Speech language therapy has recently developed a distance learning program. She developed 20 recommendations for rural health providers, managers, recruiters and regulatory authorities. Shaped through the narratives of the participants and the key themes of her research. Keyt themes were: 1) sense of connection and belonging, 2) safe and supportive practice, 3) creating roles the people want to go for. Negative press, how rural communities are talked about in the media, we are starting to believe what is being said about rural areas - that it is not as good, that people there are not as skilled, that these areas are not well resources… - we can overlook common sense and practical actions we can take. Important to think about how we value and trust staff, how we help them settle and develop local connections. Do the current policies work for local communities and local staff? Are we listening to local communities and staff, what are they telling us they need? Thinking about if what we are requesting of rural health professionals is reasonable, for example, are staff safe if they are visiting places on their own, how long will they need to travel to do their role, are we making professional support and development available. Recommendations for local health organizations: Reality check - think about is this reasonable to ask of our professionals, are we thinking about staff safety, are we designing the work for the context of rural How are you talking about rural areas? Be mindful of urban narcissism, recognize the strengths of rural communities. Represent rural professionals as valuable and knowledgeable. How you treat people will determine if people come and stay. Involve everyone in decision making. Value the learning needs of allied health professionals and make learning resources available. Recommendations for national policy: Making policies and procedures that are fit for rural communities. It needs to be flexible enough to fit rural contexts Involve everyone in decision making Be mindful of biases, use rural proofing tools to check that you are thinking rurally. Use health equity assessment tools. Education policy and regulatory policy is also important for training and regulation professions play a role in developing and recognizing rural professions, advanced practice and rural generalism. Dr Jane George on LinkedIn: Email: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/35766585

A/Prof Malin Fors - Geographical Narcissism & Potato Ethics 04/10/2025

A/Prof Malin Fors - Geographical Narcissism & Potato Ethics is a psychotherapist, author and Associate Professor at the Arctic University in Norway. Her reserach focuses on power dynamics between rural and urban areas. Episode Summary: 01.00 Dr Fors tells us about her professional background and interest in rural health 03. 25 What does she most enjoy about rural settings and what does she find most challenging? 05.45 How are challenges different for people living in rural areas regarding mental health? 09.30 What is “Potato Ethics”? 12.45 How does potato ethics show itself in rural healthcare practice? 15.52 How do new clinicians adjust to rural areas and potato ethics? 19.00 Do the differences in approaches to rural practice indicate where someone might practice in the future? What is the role of medical education? 22.15 What is “Geographical Narcissism”? 24.28 What are the power dynamics that geographical narcissism describes? 32.05 How does geographical narcissism play out in the experience of rural communities? 37.05 How does the concept of having a voice play out in rural areas? 40.00 What are some key insights that she has from her research? 44.50 What is she working on at the moment? Key Messages: Research focused on power dynamics, and became aware that power was not only in the consultation, medical records or encounter, but also in the place. Started to discover that “rural place” was rarely described in text books and missing in the discussion on intersectionality and power. Approaches rural health with a psychology gaze. She met her own geographical narcissism as she had an image of the rural world as different, or inferior or that urban standards were more normative. Enjoys that rural contexts mean you always have to stretch yourself and what you do matters, it is challenging and demanding and feels it keeps her mind sharp and developing. The most challenging is the isolation, feeling alone, feeling like the person that is always teaching and mentoring people that do not stay for long. You can feel like it is useless. It can be frustrating to not have an expert team available. People seem to be more ill when they decide to ask for help in rural areas. They are sicker because there is less healthcare. If you wait, mental health can get better on its own or it can become very serious. Colonization of indigenous peoples' lands in Norway, generational trauma following the second world war, the community is underserved when it comes to healthcare and there is a lack of specialists, this can also contribute to how they present to health services. Potato ethics is the ethics of making yourself useful. In Swedish being a potato means that you are not specialized but that you could be used for anything. It can be used in a condescending way, saying that you are not the expert. She combined care ethics and the ethics of consequences to counter the narrative that we who work in rural areas are less ethical in the way we provide care, not meeting urban standards, working on things we are not specialized enough to do, or treating people that are too close to us. Rural healthcare professionals are potatoes, they are versatile, keep track of patients, do all the tasks that are necessary. We often have to do tasks that are not done in urban areas to prevent disasters. Potato ethics is the core of rural healthcare as this is how it is organized. It is a way to describe the core of rural ethics. It is also applicable to different kinds of healthcare settings. We are assessing consequences, we know that if we don’t treat the person no one else will, so we do what we can. We can not assume that we have sent a referral and now the patient is taken care of. This is not always the case due to distance or availability. We have to make sure we follow up on our patients. Different professionals approach being in a rural area differently. Some people may start to point out errors and try to say how things are done in the city, pointing out what you should do because they can not see that the system is not working for these populations. While others ask “how can I help” because they get it. Geographical narcissism is the subtle devaluation of rural people, rural knowledge, rural experience and rurality. It is a form of oppression like others being addressed within the human rights movement. It is assumed that no knowledge could come from rural areas, can not do research, can not be in the front and that we need to conform to urban ways of doing things. Geographical narcissism is a way to have a term organized around power themes and to put the urban-rural theme under the intersectional lens. It allows us to use the other movements formulations to talk back i,e blaming the victim, aggression and “urbansplaining”. Rural expertise is not thought of as expertise, we are always not reaching the urban standards, however we are often going beyond in a lot of situation. Rural places are seen as being “the other” in comparison to urban places. Talked about almost now one living there, therefore we do not count. Often this is used as a way to explain why we are not entitled to the same services. Rural people are not important enough to get the best care. The idea that anything goes in rural areas, people that can not get a job anywhere else end up in rural areas. Can be explicit sometimes, like when people say if you choose to live rural then you have chosen to have less opportunities or less services available to you. In geographical narcissism there are patterns of devaluation, exploitation, sometimes violence, this is very similar to other types of oppression. When urban experts come to work in rural areas for a few weeks, they can sometimes speak to rural clinicians as if they do not know national guidelines or how to do procedures. Not considering that we may have been involved in developing the national guidance, do research or perform procedures independently. This can be provoking for rural clinicians and they can feel like they are being talked down to and not be seen as equal. When you have a language to name things it becomes more obvious and it is easier for people to become aware about their assumptions. We need to be able to speak with confidence about what we are doing. It is important to not only be angry but to also be open to engaging with people who have a capacity to change. We need to use different strategies to bring awareness and change. Geographical narcissism is also a political question, it is part of discussion about where hospitals should be placed, how many resources communities should be assigned, where schools are positioned and many other things. Urban standards do not always fit in rural areas, ideas about how healthcare should be organized based on urban contexts will not be effective in rural areas as the context is very different. We get told that the rural context is wrong instead of being asked what might work in our context. Rural people are told like all subordinate groups that they are “aggressive” or “will not cooperate” or “silent” and that this is why they are not being heard or listened to. Rural communities represent “counter power” as they have small and subtle ways with which they handle or respond to geographical narcissism. It has been surprising how many parallels you can see between rural-urban dynamics and other human rights issues. Website: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/35547960

Satu Pirskanen - Rural Elderly Care in Finland 03/30/2025

Satu Pirskanen - Rural Elderly Care in Finland Satu Pirskanen is a nurse and Project Manager at the Savonia University of Applied Sciences in Finland. Episode summary: 01.05 Satu tells us about her professional background and how she became interested in rural health 03.05 What does she find most enjoyable about living and working in a rural area and what does she find most challenging? 04.12 How is primary care and community care organized in Finland? 08.00 What are the main challenges facing rural communities regarding their health and wellbeing? 12.15 What is the Attraction in Elderly Care Project? 15.30 Which factors were attraction and retention? 16.30 What kind of elderly care is needed in rural communities? 18.35 What other services are used in Finland to support rural populations? 22.08 How has the tool helped with recruitment and retention? 23.41 Are there any interesting projects at Savonia University and are they looking for collaborators? Key messages: Most areas in Finland are rural areas, there are only 9 cities with over 100 000 inhabitants, over 3 million people live in rural areas. Well Being Counties took effect last year in Finland, they organize health and social care services and the financing comes from the state. Municipal health centres provide primary care and they are responsible for GP services, nursing services and maternal and child health services. They also take care of screening and preventative services. One of the core principles of Well-being Counties is that social services are integrated with primary care services. The challenges for rural healthcare: distance to services, shortage of healthcare professionals, longer waiting times and reduced access to care, telehealth access is limited due to connectivity issues or lack of digital skills, aging population with greater needs, mental health issues and social isolation, and economic constraints. Attraction in Elderly Care Project aimed to identify the attraction and retention factors for elderly care staff and develop a tool to help organizations evaluate their attraction and retention factors. Created an Attraction Model which consist of 9 factors: 1) Appreciation, “)Human resources, 3) Flexible working life solutions, 4) Inclusive and supportive staff management, 5) Orientation and student guidance, 6) Functioning and prosperous work community, 7) External communication, 8) Strong professional expertise and work development, and 9) Resource oriented approach to work for the elderly. Limited prescribing for nurses helps with access to certain medications for chronic conditions such as angina and asthma. Transportation services are available for those that have reduced mobility to help them attend medical appointments. Data from the tool shows that many of the factors still need developing at elderly care organizations. PATHS project - for self-management or co-management for elderly care, to support transition to community led care. 13 elderly care teams are progressing towards community management. They are planning to publish a guide about this process. Savonia University: Contact Satu: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/34834920

The Virtual Health Hub - Saskatchewan, Canada 03/20/2025

The Virtual Health Hub - Saskatchewan, Canada In this episode with hear from the team of the in Saskatchewan, Canada: Dr Ivar Mendez, Dr John Michael Stevens, Dr Victoria Sparrow-Downes and Joey Deason. Episode summary: 01.25 Our guest introduce themselves and tell us about their professional background and their interest in rural health 05.26 They share what they most enjoy about living and working in a rural area, and what they find most challenging. 10.15 What is Saskatchewan like? 13.08 What is the Virtual Health Hub? 15.12 How does th Indigenous perspective and culture impact the work of the VHH? 20.17 What does the VHH do? 23.11 How are new technologies used to provide care and support local healthcare teams? 29.15 Are there challenges with connectivity or maintenance of the equipment? 21.10 What other benefits does remote virtual care provide? 37.10 What kind of training is provided to clinicians engaging with the VHH? 40.43 What has the community response been to this new way of working? 49.08 What are some of the lessons that they have learned from working on the VHH? 55.35 What are the first steps to move towards developing virtual care? Key messages: Saskatchewan is the size of France with 30% of the population being rural and remote. There are many opportunities to leverage technology to improve care for rural and remote populations. Some of the challenges are: lack of resources, being away from family can be difficult, access to patients or patients accessing care, harsh climate, logistical challenges. Most enjoyable part of working in rural and remote areas is being part of a tight knit community and healthcare team. The climate is harsh, especially in the winter with temperatures up to -60C. Many of the communities are not accessible by road and can only be accessed by plane. Due to isolation there are other challenges such as access to food, some communities may only have one small general store with limited access to fresh produce. Some of the communities are 900 km away from tertiary care centres, it can be a three hour flight to reach them. This can be a barrier to healthcare provision. The Virtual Health Hub is an Indigenous led project as most of the communities it serves are Indigenous. It is a purpose built building which will have access to state of the art technology to allow clinicians to assess patients in real time and help them make a decision on the triage and treatment of patients. It is a project supported by the governments. It aims to serve about 90 communities. The Indigenous perspective is crucial in the development of the work of the Virtual Health Hub. Indigenous culture plays a role in how clinicians approach care and there is great value in having people who are familiar with the different cultures providing care through the virtual system. Projects of the VHH are primarily informed by each community's needs. They are looking to harness the strengths of local community members and seeing how they can be involved in providing care. Developed an applied certificate course which is designed to train healthcare workers from the community on how to work with new virtual care technologies. This enables them to work better with clinicians that are providing virtual care. VHH has been working with remote communities and a number of issues are clear from this work: Accessibility to timely care. Local healthcare workers can feel like they have to practice beyond their scope of practice Challenges to recruitment and retention Advanced technologies allow clinicians to support the local team and the triage of patients when it is needed. The virtual system has been able to save lives. They have very high quality video and audio connection to other clinicians which is useful for critical cases where specialist input may be required. Clinical services are provided from a distance, a remote clinic can be performed entirely via video link where patients can connect with a clinician. VHH is piloting some new technologies to see if they work in rural and clinical settings. Telerobotical ultrasonography is a project that makes ultrasound available to rural and remote communities. The ultrasonographer is in a central location, on the other side there is a robotic arm with an ultrasound probe allowing them to perform scans remotely. This has been crucial for prenatal ultrasounds. They have developed a partnership with the local telecommunications provider to ensure that they have the required connectivity and bandwidth for their service. Most of the systems being used can be maintained remotely, are reliable and can function well for long periods of time. There is a bolstering effect for recruitment and retention in these communities, the availability of remote support helps to build confidence and reassurance knowing that acute cases can be managed with a shared responsibility model. There is a large gap between telephone support and having the possibility of having an specialist see what is happening and the situation in the room and have your hands free to take action. One of the challenges of virtual care is the inability to perform a physical exam. This has been addressed by developing a virtual health hub assistant training course. These assistants would be based in the community and be able to perform some guided physical examinations. Virtual care done in the right way has the ability to increase accessibility, continuity and quality of care. They encourage a team based approach to virtual care with sharing of expertise and responsibility which builds trust and capacity. They have been working to understand patient pathways and how this can be integrated into the workflow of different clinicians. Part of their role is to make a system that is easy to use for the patients and communities as well as the clinicians and care providers. They have a technical team that provides training to support them in working with the VHH. Virtual care is about building trust and relationships. When communities receive access to healthcare they embrace the technology. They are looking to see how to incorporate translator services as different communities use different languages. Another challenge is enabling the use of virtual care for people with hearing impairment or other disabilities. Lessons learned: The importance of building solutions with the community. You have to be flexible and malleable in your vision - be willing to change what your project is or what you think you are working towards. Focus on the needs of the communities rather than fitting your ideas into the communities. Remain open minded to all possibilities. Some technologies may have been piloted in very different circumstances than they might be being used in a rural or remote setting. Trust and relationships with the community really drive successful projects. Virtual care is a new frontier and there is an underdevelopment of protocols or guidance. This development needs to be done. Advice for First steps: Understand the community and their needs. Do not underestimate the challenge of bringing virtual care into the workflow of clinicians. Be prepared for a huge project. Research is important, backing up your work with scientific evidence is important when you are trying to take new technologies and mainstream them. Collect evidence, identify what is and is not valid. Virtual Health Hub: Contact VHH: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/35211805

Prof Janessa Graves - WWAMI Rural Health Research Centre 03/10/2025

Prof Janessa Graves - WWAMI Rural Health Research Centre Prof Janessa Graves is the Director of the at the University of Washington. Episode summary: 01.00 Janessa tells us about her professional background and how she became interested in rural health. 03.44 What do you enjoy most about living and working in a rural area and what do you find most challenging? 07.45 What is her rural community like, what are some of the characteristics of this area? 11.25 What are the challenges for healthcare in rural Washington? 14.19 How is rural health research organized and funded in the USA? 19.35 What is the WWAMI Rural Health Research Centre? 22.53 Janessa tells us more about a few of the research areas that WWAMI is working on. 29.03 What are some insights from your research that could apply to different rural communities? 32.20 How is the research feeding into policy making? 35.25 How is the diversity of rural places reflected in the research and policy? 39.57 Are there programmes that are gathering data on other rural issues such as information technology and transport? 43.30 Are you working on projects that you are looking for collaborators on? Key messages: There are fewer degrees of separation between people and places where you live if you're in a rural community, it generates meaningful connections and relationships between people. The most challenging part is limited access to services, technology and experiences. Most of the urban centres, and most of the population in Washington lives west of the Cascades and then east of the Cascade Mountains there are expansive plains. 17 % of the population lives on 70% of the land mass. There are limited economic opportunities in rural areas and there is limited healthcare access. There are long distances to get to services, and there are also provider shortages. Weather impacts access to services, particularly with long distances and snow in the winter. Research is funded by federal agencies, National Institute for Health and Agency for Healthcare Research and Quality. The Federal Office of Rural Health Policy funds rural health research in the US, it was founded in the late 1980s. It focuses on issues impacting healthcare in rural America. The Rural Health Research Centre Program was established in 1988 to do rigorous objective health services research that is of interest to the national sphere and to help inform policy makers and the public with evidence to support rural healthcare. There are a number of Rural Health Research Centres around the US, they focus on different issues and cultivate researchers that are specialized in rural health research. The WWAMI Rural Health Research Centre, represents Washington, Wyoming, Alaska, Montana and Idaho, the states in the North West US. The research that it does is national in perspective. The areas of focus are rural health workforce, training of primary care providers in rural communities, substance use, behavioural health and mental health services in rural communities. Communities can come up with creative solutions to some of the challenges that they face. They need to be supported in accessing resources and capacity that may not be available locally. Rural Health Research Gateway makes all of the findings of Rural Health Research Centres available to all. This can be found at Public health and research often does not integrate the geographic component, which is so important, so doing the descriptive work on access to services or prevalence of mental health illness in, in rural versus urban communities or looking at substance use in adolescents in rural, across rural areas is still needed. All the work done at the Rural Health Research Centres is relevant to policy and policy makers. It can have a direct impact on policy and rural communities. It is important to have good representatives and empowered voices advocating for rural communities. National Institute of Occupational Safety and Health has a program on total worker health, which is not just about industrial hygiene or preventing injury at the workplace or workplace disease and illness, but also looking at shift work and access to healthy foods and this idea that it's not just a worker but that it's their total health and wellness that's important. Contact Prof Janessa Graves: WWAMI Rural Health Reserch Centre: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/34833570

Dr Bethan Stephens & Dr Katie Webb - Longitudinal Integrated Clerkships in Wales 02/28/2025

Dr Bethan Stephens & Dr Katie Webb - Longitudinal Integrated Clerkships in Wales Dr Bethan Setphens, a GP and Director of Community Learning at Cardiff university, and Dr Katie Webb, a psychologist, and a Professor of Medical Sducation at the University of Cardiff, tell us about Longitudinal Integrated Clerckships in Wales and the upcoming CLIC conference. Episode summary: 01.30 Katie and Bethan tell us about their professional background and how they became involved with medical education. 04.26 What is a Longitudinal Integrated Clerkship? 08.22 How were LIC introduced in Wales? 11.29 What were the challenges of establishing this new approach to medical education? 15.43 What are some important features of LIC and how do they enhance medical education for students? 21.15 How are communities involved in LIC? What role do they play in the student’s education? 23.55 What is social accountability and what role does it have in LIC? 26.53 What impact have LICs had on student’s future career choices? 34.15 Are there benefits for the GP practices that engage with LICs? 49.45 What is the Consortium for Longitudinal Integrated Clerkships? What is CLIC 2025? 56.11 What are the topics and themes for the CLIC 2025 conference? 01.05.00 What are their hopes for outcomes from CLIC 2025? How do they see LICs developing in Wales? Key messages: Longitudinal Integrated Clerkships (LIC): Consists of comprehensive care of patients over time while based in one community. Students that are involved have continuing learning relationships with patients, clinicians, and they meet most of their academic clinical competencies across multiple disciplines simultaneously through these experiences. A number of universities in the UK have started offering longitudinal Integrated clerkships. In Wales the government supported the establishment of LIC, it first started in Aberystwyth and Bangor. Cardiff University has been running the program since 2018. Their students are mostly based in primary care. They develop longitudinal relationships with supervisors, the community and patients. They started as a way to try to tackle challenges with recruitment and retention of GPs in rural areas. Getting initial buy-in from staff and students can be a challenge. However, the learning outcomes for students have been found to be the same as for those on the standard curriculum. Features of the LIC: students spend a whole year in one practice and in one community, social learning, having access to a team of professionals not just one mentor, continuous learning which improves the learning cycle, builds confidence and students become more independent and they develop a deeper understanding of the social and health system context. Students develop a sense of belonging during their time in the community. This can lead to a feeling of responsibility for the community. Many of them choose to help during COVID with patient care and vaccination programs. Students live and work in the area for the year and join different community activities. They work on a student selected project, this project often looks at providing a new service or evaluating an existing service. Social accountability in LIC means that the student thinks about how to co-produce things with the community, gets them thinking about what the community needs and how to meet those needs through working with the community. There have been around 30 graduates to date from their program. Around half of those have opted during their time to stay in Wales. They have expressed interest in staying in the same area or working in another rural area, others have changed their career preference towards general practice. Indications at this early stage are positive. Information about CLIC 2025: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/34822820

Prof. Karen Flegg - Rural Health Leadership 02/20/2025

Prof. Karen Flegg - Rural Health Leadership Professor Karen Flegg is a rural general practitioner from Australia and the current president of . Episode summary: 01.04 Karen tells us about her professional background and her journey into rural health. 04.20 What has she most enjoyed about living and working in a rural area and what does she find most challenging? 07.50 What has her rural leadership journey been like? 14.30 How did she go from a rural doctor in Australia to the president of WONCA? 19.15 What are some of the challenges that she has faced during this journey? 24.45 Do some of the challenges prevent rural doctors from taking up leadership roles? 26.19 What does taking up a leadership position bring to your rural practice or rural area? 28.50 Is it important for younger colleagues to develop leadership skills? 34.15 How can rural clinicians advocate for their communities and what are some lessons that she can share? 37.10 What would she like to see for the future of family medicine and rural practice? Key Messages: The experience of having great supervisors and mentorship in a rural environment. Colleagues stick together, provide advice and do some communal thinking on difficult problem Most enjoys the community, knowing neighbors, and the community spirit. Challenges can be the social situation, the difficulty of finding friends rather than just people that are friendly. As the new doctor was invited to join the board of the community information centre, this was her first experience as a chair of a board. Had an opportunity to join the board of the Australian College of General Practitioners, the reality was not what she expected. Realized quickly that she needed a mentor. She did not actively seek leadership roles, sometimes you just say yes. Applied to be the WONCA editor and held this role for 10 years. Through this role she got to know many people from all over the world. During that time also stood for WONCA executive. Being a rural doctor has helped as it was important to have a broad understanding of what family doctors do all around the world. Living in a place that had easy access to an airport and good internet access was an important consideration for an international leadership role. A challenge can be understanding governance to effectively chair a board. She actively sought to learn about governance and business skills. Concerned about planetary health, however, as WONCA president has to travel as part of her role. Balancing leadership with clinical roles can be difficult particularly with recurrent trips overseas. She has found a part time role that is flexible and this is not always possible for everyone. She had a break from some of her roles due to other commitments, the location where she was living and other circumstances at the time. There is an element of excitement in the local community when you hold a regional, national or international leadership role. The community is interested in what the local doctor is doing. Young rural clinicians should say yes to opportunities. Getting involved in different WONCA working parties and special interest groups is one way to do this. If you can go to a conference, present something. In 2025 there are WONCA regional conferences in April for the South Asia region and Asia Pacific region, and the World conference in Lisbon in Portugal in September. There are Young Doctor Movements in each world region that colleagues can get involved in. The networking is the best thing about conferences. Networking is part of leadership, the opportunity to meet people and have a chat with someone from a completely different part of the world and learn from each other. If you are going to advocate for your community it is important to get a team around you and networking in the community to understand different views within the community. Someone might be better fitted to lead advocacy efforts and it might be that the family doctor works in the background. Leading from behind - mentoring other people, delegating to others who might be better suited to the task, networking and having a team of people who are involved. It is lonely being a lone ranger. She would like WONCA to be the go-to organization to advise on primary care and family medicine. Rural workforce issues are most concerning. Rural communities and rural doctors are aging. She is keen to give medical students exposure to rural practice and rural training. WONCA has a special interest group for policy advocacy. They are thinking about leadership and advocacy. There is also a young doctors leadership program that has been launched recently. There are many opportunities to step up and get involved in leadership. WONCA conferences: WONCA working parties and special interest groups: Young Doctor Movements: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/34658125

Dr Chris Rice - Nurse Recruitment & Retention on the Scottish Isles 02/10/2025

Dr Chris Rice - Nurse Recruitment & Retention on the Scottish Isles Dr Chris Rice is a qualified nurse and paramedic, and Associate Head of Postgraduate Medicine at Edge Hill University in Lankashire. His doctoral thesis explored the recruitment and retention of nurses staff across northern Scotland’s non doctor islands. Episode Summary: 01.30 Chris tells us about his professional background and how he became interested in rural practice. 03.25 What does he most enjoy about working in a rural area and what does he find most challenging? 04.57 What are the health services and the population like in Shetland? 10.45 Why did he choose to research recruitment and retention of nurses on the Scottish Isles? 12.05 What are the skills and competencies that nurses need to work on the Scottish Isles? 17.19 How is the infrastructure on the islands? 19.00 What are the opportunities for training or professional development on the Scottish Isles? 21.10 What were the insights that he had from his research on recruitment and retention? 24.33 What factors play a role in retention? 27.37 What are younger nurses not choosing to come to the isles? 29.45 What are his recommendations for improving recruitment and retention of nurses? 34.30 What is he working on currently? Key Messages: The biggest reward is holistic patient care, getting to know the patients, becoming part of the community, and a sense of belonging which is unique to rural practice. Challenges - being on-call 24h a day, being the only medically trained person on the island. NHS Shetland covers a population of about 22 000, there are about 5 no-doctor islands, they are remote and accessible by boat, plane or helicopter. Population on these islands varies from 15 to 450 members of the community. Depending on the weather it can be challenging to transport patients off an island, they collaborate closely with other emergency services and they have equipment on the island to help them manage critical patients when needed. The healthcare professionals on the ground on the islands are usually nurses who are there 24h a day, living on the islands, provided with accommodation and transport. Patients are linked to a local GP who may or may not be based on the island. What drove him to move to the Scottish isles? He wanted new challenges for his practice, delivering continuity of care and being part of the community. He wanted to understand what drove others to make a similar decision. A variety of skills are needed, primary care, emergency care and chronic disease management. There is always somebody at the end of the phone, there is always a GP on-call, an advanced practitioner or emergency services. Ultimately you still need to make the clinical decision for the patient in front of you. Provided with trauma and emergency training and the Sandpiper trust provides training and a bag with emergency equipment. The majority of nurses came to the isles for a change of career, they were looking for something different. Many of them came to the isles ahead of retirement. The majority were over 50 yrs of age. The nurses were from A&E, GP or acute medicine backgrounds. Work-life balance was a key factor for retention of nurses. The community finds work for partners of those coming to work on the isles. Younger professionals are more focused on building a career and this can be easier in more urban areas. The younger generations tend to go off island to get the experience and build careers and then they return later in life. It is important to have an open and honest dialogue about what the job is and what to expect. There are new training pathways being developed for rural and remote practice. Contact: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/34657225

Susanne Tegen - National Rural Health Alliance 01/30/2025

Susanne Tegen - National Rural Health Alliance is the CEO of the National Rural Health Alliance in Australia and an advocate for rural communities. Episode summary: 01.15 Susanne tells us about her professional background and how she developed her interest in rural health. 06.00 What does she find most enjoyable and most challenging about living in a rural area? 12.50 What is the National Rural Health Alliance? 17.55 How did the membership organizations come together to form NRHA? How did that aid advocacy efforts? 21.20 What are some of the main challenges facing rural Australians when it comes to their health and wellbeing? 28.05 How is the NRHA trying to address some of these challenges and what is their role? 35.50 How does the NRHA work with others outside of the healthcare sector? 41.15 What will the NRHA be focusing on over the next few years? Key Messages: Addressing population health needs, and dealing with solving problems when you don’t have all the ingredients you need. Lucky to have amazing space outside of the city, gives you peace of mind and time to reflect and think. Sun up and sun down, smells, bird sounds, it really centres you. People pull together after disasters, sterling examples of innovation and resilience. The hypocrisy of rural people being seen as “hicks” as they may not look like they are well educated. Two thirds of Australia’s export income comes from rural, remote and regional Australia and so does 90% of the food that Australians eat, and they bring in 50% of the tourism income. Rural people make up 30% of the population (7 million people). Everything is more expensive, the “tyranny of distance” places stress on individuals, businesses and communities. Rural communities are more sensitive to economic downturns. In Australia people are dying 12-16 years earlier in rural and remote areas than in the cities. The National Rural Health Alliance (NRHA) is a non-profit, funded by membership fees and the federal government. An agency with 53 members, entities that work along the patient journey or in health workforce education pathways. Supports researchers in rural Australia. Geographical narcissism where we have a belief that if something is developed or driven by the city it must be good, but if it is driven by people on the ground that its second rate. It isn't, but it's different and it may need different funding models. NRHA looks at increasing the understanding of issues facing rural health, workforce shortages, socioeconomic needs of rural communities, they advocate for collaboration based on values and need driven with the community being part of the development of initiatives. NRHA reminds the government that taxpayer money which is to be used to meet the needs of the citizens. NRHA is now 35 years old, in 1991 the first National Rural Health Conference was held in rural Queensland. NRHA has been promoting working together of national and federal governments and advocating for a national rural health strategy. Rural Australians are sicker and are dying up to 16 years earlier. More than 50% of rural doctors are international medical graduates. Revolving door of clinicians, doctors, nurses and allied health professionals, many communities are feeling let down and not supported. From research of government funded programs, rural Australians are getting AUS$6.55 billion per annum less spent on them, this is about $850 less per person. Rural and Indigenous students are much more likely to return to their rural and remote communities to work after graduation. Big issues: workforce, population health needs, underfunding and inflexible funding, multidisciplinary care, possibilities, governments working together and seeing the importance of governments working with communities. NRHA is on a number of ministerial committees who are involved in setting policies and providing feedback from the grass roots. NRHA participates in state and federal senate inquiries and they provide submissions for questions relating to rural health and rural communities supporting their members to provide evidence and asks aligned with shared goals. NRHA works closely with other industries based in rural communities as they are important for the health and wellbeing of those communities. The value chain is not just health. NRHA has asked for AUS$1 billion over 4 years and 50% of that to be block or blended funding for those communities and regions where the market has failed to support infrastructure and the other 50% to go towards health services. We need to do something differently as we now have the data and know that inequalities exist. What will NRHA be focusing on over the next few years? 1) Australian National Rural Health Strategy this includes the AUS$1billion fund, 2) building a community of practice through developing a Rural Health Hub, 3) closing the gap regarding Aboriginal health access, 4) working with communities for disaster planning and resilience, 5) supporting clinician wellbeing, 6) advocating for more funding for rural research, and 7) international community of practice. NRHA website: Email Susanne Tegen: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/34569905

Welcome to Season 3 01/20/2025

Season 2 - Wrap Up 12/10/2024

Tony Joy - Empowering Rural Women and Communities (Durian) 11/20/2024

Tony Joy - Empowering Rural Women and Communities (Durian) is the founder of , an NGO focused on empowering rural women to become self-sufficient by providing them with the knowledge and skills needed to transform their local waste into a means of livelihood. Episode summary: 00.55 What inspired Tony to work on rural issues and with rural women? 13.45 What is the perception of rural communities in Nigeria? 20.10 What is life like for a woman living in a rural area in Nigeria? 27.15 What is Durian? What does it do? 35.40 Why is it important to engage rural women? 39.00 How has the mindset transformation impacted women that Durian works with? 44.20 What does she hope for the future of Durian? 49.15 What projects is Durian working on? Key messages: Young people are often told they are not doing anything, that they are good for nothing and that they are not contributing to the economy in the African context. These are also things that people in villages are told. In 2016 started a project to show the community how to transform plastic waste into new products. Realized that they needed to use local waste and local resources to solve problems. There is no community that does not have some kind of resource. The community needs to understand how to use those local resources as a tool and own it to find solutions and a means of livelihood. Rural communities are seen as places to exploit. They are the poor, marginalized and forgotten places. The new drive towards exploitation as they are seen as green areas that real estate agencies buy to turn into new property developments, or large businesses buy the land and use the natural resources for business purposes. Rural communities are losing all their green areas, it has been filled up with houses and shops. Farmers have lost land in their own communities and they are having to lease land in other areas so that they can continue with farming. Women are already disadvantaged, rural women are even more disadvantaged. There is a culture that says that a man is in charge of a woman, they determine their life, where they can go and what they can do. Young women are encouraged to get married early. These women have dreams but do not have the opportunities to achieve them. Women do not have rights to own land. It is seen as culturally wrong. Questions start to be asked about where she got the money, if she is trying to compete with men, or who she thinks she is. Nigeria is a large country with diverse cultures. In some areas the women are the owners of the land or own small businesses. Choose the name Durian as it is a fruit that stinks but tastes good. This reflects Tony’s story and the story of the women that she works with. Rural communities are poor, marginalized and underdeveloped, but they are the future. Waste is the future and supports sustainable communities. Encourages to see beyond the stink, the obvious and the ideologies, look beyond that and see the opportunities that exist. Durian is working on creating sustainable systems and structures in places where they are told that they can not do it. Showing communities that they have a resource that can be used to develop their livelihood. Supporting women to become the drivers of change in their community. Creating new identities for the women and their communities. Women are incredible story tellers, they can take knowledge from one generation to the next easily. When they work with a woman they transform the future of their whole lineage. Many communities already have an idea of what they want to do. Durian supports them in developing the skills and knowledge that they need to achieve this. If you want to create sustainable change in a community and have it a system then you need to engage local women. Women have always been silenced, and creating a space for them means a lot of transformation in communities. If you want to work in rural development, you need to be there and you need to invest time to see real change and transformation. A lot of work to be done with mindset, ownership, resource management, green environment and more. Rural Rights Network - they learn about their rights and they stand up for their rights now. Durian hopes to become the leading organization in Africa for sustainable, systemic and human centered rural development approaches. An organization that is redefining rural and highlighting the beauty and strengths of these communities. They want to close the gap between research and implementation. Rural people need to speak for themselves. Durina has started a Green Fellowship which trains rural enthusiasts around Africa (Kenya, Malawi, Uganda, Zambia, Nigeria). They are looking for partnerships to support fellows in implementing projects. Rural Rights Network looking for partnership with human rights organizations to support legal processes when this is needed. Durian is looking for research partners to improve the products and processes that are being developed with waste and repurposing in rural communities. Learn more about Durian here: Contact Tony: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/33960327

Sadie Lavelle Cafferkey - Nurse-led Addiction Model of Care 11/10/2024

Sadie Lavelle Cafferkey - Nurse-led Addiction Model of Care Sadie Lavelle Cafferkey is a registered nurse working on in the Republic of Ireland. She is currently doing a PhD with Trinity College Dublin. Her project is looking at developing integrated nurse led addiction services for rural communities. Episode summary: 01.10 Sadi tells us about her professional background and how she became involved in the field of addiction. 04.00 What has your research shown about historical data on addiction in rural hospitals in Ireland? 07.35 What are some of the triggers for addiction in rural Ireland? 08.15 What services are currently available in rural areas? 10.15 What is an addiction cycle? 13.40 Why are you advocating for nurse-led models of care? 16.50 What would need to be implemented or changed to enable nurse-led models of care? 19.15 What is your advice for health professionals supporting people with addiction in rural areas? 25.50 What do we need to be aware of in regard to the experience of people with addiction in rural areas? 30.50 What are the main findings of your research so far? 30.25 What are her three recommendations for how to move forward? Key messages: During her masters she learned about the lack of resources in urban settings relating to addiction services, she became interested in exploring the situation for rural areas. Her PhD is focusing on providing a nurse led addiction model of care for resource poor and rural settings and it is a mixed method study. A 10 year retrospective analysis showed that alcohol is a significant issue but there are also pockets of certain substance abuse in different hospitals. Nurse led model of care will not be a one size fits all, it will need to take into account what the patients need, what the hospital needs and what the nurses need to make this approach work. Local rural services are inundated, hospitals are seeing a rise in people suffering from alcohol and substance abuse. However there are no addiction services to refer them to. A person will come into the hospital while under the influence of a substance, they have their medical condition treated and they might be offered detox. Following this they are discharged without any support offered in the community. The person then slips back into addiction. Why nurse-led care? Nurses make up nearly half of all healthcare professionals, this makes them accessible. They provide 24 hour, 7 day a week care. Nurses are good with health education. Nurses are adaptable. Nurse led care is very safe and very effective, it saves governments a lot of money. Patients trust their nurses. Nurses advocate for their patients. What would need to change to enable this approach? The way that things are recorded and reported. Nurses need to be able to specialise in addiction care and they need to be able to prescribe. We need to change minds to allow for changes to happen. Rural communities benefit from nurse-led models of care. Taskforce for drug and alcohol, they can be a resource for supporting clinicians. The “Healthy Options Clinic” was something that the nurses started to reduce the stigma of attending the surgery for substance use issues. Access to services, access to the internet, access to public transport, all of these factors can be barriers to seeking help. It is not just a healthcare issue, we need support from other sectors to enable good care. The environment needs to be stigma free and safe. The nurses need training and upskilling along with support form leadership and management Nurse prescribing is important in substance use clinics. Having rapport with patients is important for providing care and finding out what they need. We need a better reporting system to gather good quality data. We need better digital services in rural areas. How to move things forward? Digital, nurse prescribing and good quality reporting system. Online course on addiction treatment: Contact Sadie at: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/33861717

Dr Juan Barranco - Rural Health in Spain 10/30/2024

Dr Juan Barranco - Rural Health in Spain Dr Juan Barranco is a rural family medicine doctor from Spain. He is a member of the EURIPA International Advisory Board and a member of the rural section of SemFYC an organization for family doctors in Spain Episode Summary: 00.49 Could you tell us about your background and how you became involved in rural health? 02.45 How is primary care in rural areas organized in Spain? 05.41 Who are the members of the primary care team? 08.54 What are some of the challenges faced by rural communities in Spain regarding healthcare? 11:04 Does Spain have rural training pathways for students and clinicians? 15.18 Could you tell us more about how the rural health group within semFYC? You hold a rural health conference every year, could you tell us more about the next conference that will be held in October this year? 20.33 You hold a rural health conference every year, could you tell us more about the next conference that will be held in October this year? 23.05 What do you enjoy most about being a rural family doctor? 25.56 What are your top 3 tips for people thinking about a career in rural health? Key Messages: Primary care in Spain is organized by the public administration, there are 17 regions. As a doctor you compete with other doctors for positions that are available and according to this you are allocated to a particular location. Not many doctors compete to work in rural areas. There are places in rural areas that are missing family physicians. In Andalucia there are challenges and there is a lack of health workers in rural areas. Spanish doctors are moving to other countries in Europe and there are doctors from abroad, from South America, coming to work in rural areas of Spain. Varied population for which he provides care which includes a lot of complexity- for local communities, local care homes, and migrants that have moved to the area. Students and trainees are exposed to the complexity of care provided in rural areas and the types of challenges and problems that rurality brings. Rural experiences for medical students are not very common in Spain. There is limited education on primary care as medical education is very hospital centric. The only exposure to rural medicine is during family medicine training as every trainee needs to spend time in a rural setting. There are no current support networks for doctors choosing to work as a rural family medicine doctor. Adapted training for rural areas depends on individual tutors that trainees have exposure to. There is not a standard curriculum for rural skills. The rural section in SemFYC aims to promote rural medicine, organize an annual rural forum, provide rural specific training and support for rural clinicians. The annual rural health forums have more than 300 GPs. There is a revival happening in rural medicine in Spain as doctors are looking for places where they can practice real family medicine. This year's forum is planned for October in Trujillo and will have a focus on mental health. They are inviting organizations of rural women as these associations are very active in community life. What does Juan like the most about being a rural doctor? Being a generalist and dealing with complexity. What does he find most challenging as a rural doctor? To stay connected with others. There are 50 people working in the health center but most days he is working on his own with his nurse. Top tips for people thinking about a rural health career: 1) Every doctor could develop a high quality career in a rural setting, 2) Be brave and step out of the mainstream especially if you are young and exploring options for your career, 3) take the opportunity to discover rural medicine. Rural Health Conference in October 2024: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/33429812

Prof Jean Ross - Global Rural Nursing Exchange Network 10/20/2024

Prof Jean Ross - Global Rural Nursing Exchange Network Prof Jean Ross is a professor of nursing at Otago Polytechnic in New Zealand with many years of experience advocating for rural health and rural nursing. She is a member of the Global Rural Nursing Exchange Network leadership team. Episode summary: 00.45 Could you tell us about your professional background and how you became more involved with rural health? 06.06 What is the state of rural nursing in New Zealand? What role do nurses have in NZ rural health systems? 10.53 What is the Global Rural Nursing Exchange Network? 12.57 What are some of the challenges that nurses face when wanting to work in rural areas? 14.42 What does the Global Rural Nursing Exchange Network do? 17.44 How can the network support students and nurses? 19.12 Do you collaborate with any other healthcare networks? 22.08 What are your plans for the year ahead? 27.10 Are you looking for any collaborators for any upcoming projects? 28.00 Where can people learn more about GRNEN? Key Messages: In the early 1990s there was a big movement around rural health in New Zealand led by general practitioners who were raising the issues of maintaining care in rural areas. In 1994 the first Centre for Rural Health was set up in New Zealand, Jean worked on this with Martin London. Last year (2023) the first ever National Rural Health Strategy was established and is now part of the government mandate in New Zealand. Rural nursing has changed significantly over the last 30 years relating to legislation and regulation. Movement for continuing education for nurses and the Health Practitioner Competence Act. Survey on nursing on the South Island - it was not just practice nurses looking after the population, there were nurses with many different titles. It looked at what is their practice, what they do, how they are paid, who does what, why and how, how are they supported and what is their education. The survey found that they required a specific tailored education and a support network. In 1996 a postgraduate certificate was established for rural primary care supported by the University of Otago. The Global Rural Nursing Exchange Network (GRNEN) was formed so that rural nurses could share and exchange their experiences with others globally. Due to COVID19 physical exchanges were not possible. Education can be one of the challenges faced by nurses in rural areas, there is isolation, limited transportation, lack of access to services. The majority of nurses are women and often take on additional responsibilities in their personal lives and in the community. This can affect the time, space and access to continuing education. GRNEN established and online space for rural nurses to connect, talk together, support each other and learn from each other. On the website there is a virtual library of resources which is free to access. GRNEN is developing a number of educational modules for rural nurses, exploring rurality and career development. GRNEN has a focus on students, there are a number of grants available for students to exchange their understanding or rural practice with a counterpart form another country. CHASE Model - Community Health Assessment Sustainable Education Model. This model has three stages and 11 phases. GRNEN: CHASE Model: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/33429657

Gréanne Leeftink - Rural Health & Mathematical Models 10/10/2024

Gréanne Leeftink - Rural Health & Mathematical Models is an assistant professor within the department Industrial Engineering and Business Information Systems, in the research center at the University of Twente. Her research focus is on healthcare process optimization, using Operations Management/Operations Research techniques. Episode summary: 01.14 Greanne tells us about her professional background and how she became more involved in healthcare in rural areas. 04.55 The University of Twente and the work of the CHOIR research center. 09:14 What can mathematical models bring to primary healthcare? 13.24 How do mathematical models apply when dealing with limited resources? 15:33 The importance of taking variability into account in those mathematical models. 22.08 The Virtual Care Centre of Isala. 27.08 What has the feedback been from healthcare staff and patients? 30.41 How were the healthcare professionals involved in implementing/developing that idea? 32:00 Were there any issues with digital literacy and how do you deal with these? 34.35 How do mathematical models have been applied to the challenge of freeing up clinical time? 37:08 How widely are these being used in the Netherlands and in Europe? 39.46 Key insights from Greanne’s research regarding how care is provided in rural areas. 41:49 What other research is planned at the CHOIR and the University of Twente. Key messages: CHIOR Research Centre is one of the world's largest research centers on healthcare logistics. In industry and business all processes are optimized to the tiniest detail. People say that this can not be applied to the healthcare setting. However the same mathematical principles apply to healthcare and can be applied to healthcare settings. CHIORs mission is to help healthcare organizations improve their quality of care and quality of labor and efficiency by redesigning their processes. Rural health has challenges such as access to care, drug availability, supply chain reliability, emergency response, cost efficiency etc, which all have a logistic component to them. Rural populations deserve to have the same quality of care as the urban population. They worked on a mobile care clinic which provided care in different villages. They needed to determine what the optimal location of the mobile care clinic would be to ensure that all the villages were served at least once every second week. They used mathematical models to determine this. Access once a week or every second week is often not enough, so they factored in having a van in an area that was more accessible in regard to distance every 48 hours. Capacity management which entails planning and scheduling solutions which focus on efficient deployments. Using mathematical models they have created better work schedules with more evenly distributed workloads. This can reduce work pressure for employees and improve efficiency by 15-50%. What can mathematical modeling bring to a primary care center? It can address the challenge of variability of workload. If we can quantify the variation to some extent, we can plan the work schedules in a better way. Sometimes it is important to recognize that some things in healthcare can not be fully optimized, you have to accept that sometimes certain resources and staff will not be fully utilized, however this flexibility is important for staff satisfaction. Rural care is by its nature less efficient, and sometimes the conversations stop here and the recommendation is to pool everything in cities. However this is not the best approach. A way to approach this is task differentiation or by taking on a different type of activity, for example having physical consultations combined with digital consultations. They look at a process and try to grasp the notion of variability in that process, then they try to reduce that variability. However at some point you can not reduce this variability further. So we have to try to adjust your capacity to the variability and this can be done by having flexibility. Allocating flexibility is unique to each situation, one way will not work for everyone. The solution that works for the neighbors may not work for us. In the Netherlands women have the right to give birth at home. They used a simulation model to see how many midwives would be needed to provide good quality care to rural women. Long and variable travel times and an increase in the number of births affected availability of midwives particularly in summer months so pregnant women would be asked to go to the birthing center in the summer to reduce risks. During the rest of the year rural women can give birth at home. Isala Hospital Virtual Care Centre has a program for connected care. The aim is to bring care closer to patients home using remote monitoring to reduce time spent in hospital or the need to attend clinic appointments. Remote monitoring solutions are becoming more reliable and they provide opportunities for people to maintain independence and receive care in their homes. Modeling and data analytics in healthcare has grown in recent years. In hospital settings this is used more often with dedicated capacity managment teams for planning and scheduling from strategic to planning level. Now primary care is also interested in exploring this approach. CHIOR at the University of Twente: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/33397267

Cristobal Escalona - Rural Innovation and Sustainable Development in Chile 09/20/2024

Cristobal Escalona - Rural Innovation and Sustainable Development in Chile Cristobal Escalona is the director at Balloon Lab at Ballon Latam, a social enterprise supporting rural innovation and sustainable development in rural areas of Chile. Episode summary: 01.00 Cristobal tells us about his professional background and how he started working with rural communities. 07.45 What is Balloon Latam and where did the idea originate from? 14.00 Why are the activities of Balloon Latam needed in Chile? 19.40 How does social entrepreneurship build social capital and encourage social participation? 26.30 What are some of the big challenges that they are trying to tackle and how are they approaching them? 35.30 What is the index for community resilience? 44.55 What new initiatives is Balloon Latam working on? 49.10 How is health and wellbeing being addressed in rural areas of Chile? Key messages: Balloon Lab is the innovation and research department at Balloon Latam. Balloon Latam works with entrepreneurs in rural communities. Nationally and at system level there are competing priorities. Not everybody thinks about rural communities and rural problems. It is important to create change in the communities that are at risk due to lack of investment. Founder of Balloon Latam adapted the business model canvas to rural contexts. Working with rural entrepreneurs is just one program that the company works on. Balloon Latam is a social enterprise and B-corp, they want to show that there can be a viable and sustainable business model and sustained impact in rural areas. They work with intangible assets such as networks and trust. As part of this work they have developed a community resilience index to make their work more tangible. Chile has beautiful natural landscapes, the capital Santiago is very developed, this is not the case in rural areas, unfortunately Chile has a high GINI index and there are inequalities in access to wealth, health, education and transportation. The Chilean government struggles to reach rural areas, because priorities shift, some communities are very remote or due to conflict areas. There is a need for a sustained approach to working with rural populations. Chile is a very diverse country with different cultures, landscapes, and temperatures. It makes it difficult to create a policy that meets the needs of all those communities. Balloon Latam brings together local entrepreneurs to help build capacity by teaching skills and it also gives them an opportunity to connect with other rural entrepreneurs. This activity in itself builds social capacity in the local community. They can then leverage these relationships and trust to build community projects and initiatives. Social capital and community engagement is built into the way that they work. An overarching challenge in Chile are natural disasters such as flooding. These threats are happening more often and more severely. Soil is important and they are looking at how they can restore soil and promote resilience with the community sustainably. Community based solutions that Ballon facilitates are necessary but they are not enough given the severity of the issues, however they can validate that addressing these issues are important and this can create system change. They have been exploring ways to build community intelligence on disasters and environmental threats. It is interesting that usually the only people that participate in such exercises are qualified informats or scientists, no one has asked the community members who have lived there for a long time. It has been interesting to see what happens when they discuss the issues together and bring their different perspectives. They do impact evaluations of their programmes to help collect evidence. They noticed that there are no numbers on public infrastructure that is insured, how many people are trained in first aid, emergency vehicles in the ares, no quantitative measure of potential losses, no one knows how much is being spent on resilience. There was no way to calculate the impact of initiatives without this baseline. There is so much information that we need and we don’t have. Trying to solve the gap between territorial knowledge and the GIS information that governments use to make decisions. They created a resilience index and are now implementing it. They have just finished a pilot in one rural community which has a disaster unit. This is an outlier and positive example of community resilience. Access to water, water sanitization and lack of water keeps coming up in their work. Chile has a desert and also lush forest areas. Water plays a vital role. Distance, geography and access to healthcare remains a challenge in Chile for the health and wellbeing of rural people. Balloon Lab: Ballon Latam: YouTube: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/32860692

Dr Anette Fosse - Norwegian Centre for Rural Medicine 09/10/2024

Dr Anette Fosse - Norwegian Centre for Rural Medicine Dr Anette Fosse is a rural GP and researcher at the Arctic University of Norway. She is also the director of the Norwegian national center for rural medicine. Episode summary: 00.45 Anette tells us about her professional background and how she developed her interest in rural health and research 04.00 How is the healthcare system organized in rural Norway? 06.05 Who are the members of the wider primary care team? 09.30 Do the medical secretaries receive specific training? 10.45 What are the characteristics of arctic populations? 14.30 Are clinicians trained to deal with more extreme conditions and isolation? 16.00 What is the Norwegian center for rural medicine? 17.55 What kind of research has been done by the Norwegian Center for Rural Medicine? 20.45 What were the insights that came from the research on medical education for rural areas? 26.30 Have there been challenges to find mentors or clinicians to supervise students? 28.05 Are there support networks for clinicians in rural areas? 29.30 What has caused the increase in the use of locum doctors and what were the findings of the research? 34.42 What are rotational positions for doctors and how are these being used by municipalities? 40.00 What other research is planned at the Norwegian Center for Rural Medicine? 44.15 What are you top three tips for people thinking about going into a rural health career? Key Messages: Primary care is organized by the municipalities, the general practitioners are contracted by the municipality. In rural areas there is not a market for running your own general practices so the practice is run by the municipality which employs GPs. All GPs with a contract with the municipality have a duty to participate in out of hours services. Every citizen in Norway is entitled to have a named GP, the average list is 1000 patients. In rural areas the GPs have fewer patients on their list, however they perform other duties such as out of hours, monitoring care homes, and child preventative care. Average practice does not have nurses or other allied health practices, there are health secretaries which take phone calls, then can do ECGs, wound dressing, things which may be done by nurses in other countries. Norway is starting to introduce nurses into general practice. Medical secretaries receive 2 years of training. They are not trained to the level of nurses. Weather can affect travel significantly for patients, some communities can be cut off and isolated. There is no standard training for rural practitioners in Norway. There is a good system for specialist training for family medicine, they all take an emergency medicine course and collaboration sessions with local ambulance services. The Norwegian Center for Rural Medicine is a national center focused on improving recruitment and retention, research and education. It has been supported by the government since 2007. They aim to bridge health, academia and policy to work together to address challenges. “Making it Work” - a research project looking at recruitment and retention. Systematic review on educational intervention to ensure provision of doctors in rural areas trying to find the answer to what medical education needs to provide to help students choose rural practice. Last year they did research on the use of locums as the use of locums is exploding in rural areas. Project on primary healthcare teams looking at how to include nurses into general practice. University of Tromso was one of the first medical schools to be located in a rural area due the need for doctors and other healthcare workers in the region. It was established in the 1970s. The things that have been found to increase amount of students choosing rural practice are: Preferential admission from rural areas. Curriculum relevant to rural medicine. Decentralized or distributed medical education based in rural areas. Practice oriented learning in rural areas. All of the medical schools in Norway have started to apply distributed medical education, sending students to smaller towns. It is not difficult to get GPs to supervise students in their practice, what has been more difficult is to get rural GPs to teach at the University in Tromso. All trainees have to join a mentor group with other specialist candidates and a supervisor, those groups will often be located within the same regions and they can share experiences. When the crisis reaches the cities that means that there has been a crisis in rural areas for a long time. The authorities often only start addressing the issue once it is visible in rural areas. From 2016 to 2022 the number of locum contracts in GP surgeries increased 446% in all of Norway. In rural areas the increase was 659%. In rural areas locums were covering positions for a shorter duration of time than in urban areas as they would need to cover 100% of a position, while locums in urban areas might be there for longer by often covering part-time. Locums are expensive with locum agencies earning large sums. GPs can earn triple what they would earn if they were salaried and they can work more flexibly. Rotational positions are a way of organizing general practice in areas that have been dependent on locums for a long time. It is inspired by the off-shore positions in the North sea. Doctors work 3 weeks on and then 3 weeks off. Three doctors would then cover one full time position. The municipalities have noticed that there are no applications for the normal salaried positions when they are advertised but when they advertise a rotational position they get 20 or more applicants. Top tips: Seek a well functioning practice and a mentor Seek clinical courage, curiosity and flexibility Potato ethics - doing things outside of your comfort zone because you are the only one that can do this Be involved in the local community, get to know where you live and work. Norwegian Centre for Rural Medicine: Contact: Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/32860642

Dr Rebecca Orr - Farmer Health 08/30/2024

Dr Rebecca Orr - Farmer Health Dr Rebecca Orr is an academic GP from Northern Ireland who focuses on farmers' health. She is also the Chair of the Agri Rural Health Forum in Northern Ireland. Episode Summary: 00.45 Rebecca tells us about her professional background and how she became interested in rural health and farmers health 04.00 What is the role of women in farming and the health of rural communities? 06.50 What is the NI Agri-rural health forum? What work do they do? 21.20 Why are you researching farmers' health? How important has it been to include farmers in the research process? 34.45 What were some of the key findings of her research? 39.25 What should clinicians be thinking about when they are caring for farmers and their families? 47.00 What are your top three tips for people thinking about going into a rural health career? Key Messages: Even though about 86% of those in farming are men, women have always played a huge role in farming. The NI Agri-rural health forum started in 2021. They have a role to bring everyone around the table to talk about health, they bring together agriculture, public health, voluntary sector, government and commercial organisations. Key aims of the Agri-rural forum are to share information between the different stakeholders. The forum holds panels, workshops, developing a network to help partnerships flourish. Researchers have come to speak to the Agri-rural health forum, this has provided inspiration for other activities. Decided to focus on blood pressure and cardiac health. Teamed up with the British Heart Foundation to develop tailored health materials for farmers. “You might know your tire pressure, but do you know your blood pressure”. Developed a 5 year plan for what they would like to work on next. One of the next topics is respiratory health and occupational lung disease in farmers. One of the challenges was to find a way to bring different partners together who may have different interests and targets, building trust is a big part of this process. There is a gap in knowledge about farmers' health in the UK and Northern Ireland, especially linking it to primary care. How does the change in farming practices affect farmers’ health? There is a divergence in mortality among farmers compared to the general population. They got farmers involved in the research study. The question is: what factors influence the behaviour of farmers at risk of cardiometabolic disease? The farmers informed the choice of the research methods and they were involved in the development of the survey. They used the COM-B framework, farmers understood this framework and got behind it. Farmers analysed the questionnaire, edited it together and they took ownership of the research protocol with the research team. It has been important to give feedback regularly to the farmers (participants) on the progress of the research and the insights that were gained. It is important to involve them in the discussions around how the data and insights are interpreted. Farmers were asked to rate their top priorities, they responded with farm and family health and then personal health were their priority. When asked what the priority of their peers is they answered farm financial health. Key findings so far: - Risk taking, one farmer said “we are actually gamblers”. Does that feed into their choices around health? - Optimism - that thing will work out - Sense of responsibility - they take responsibility for optimised farm health - Self-sufficient - feeling that they have to figure things out for themselves - Seasonality - Planning Advice for clinicians: Farmer clinic - don’t need an appointment, they can just turn up Be straight talking - if there is a risk they want to know about it in clear language Farmers experience life and death and are aware of the fragility of life and some of the physiology Trust - the clinician being seen as part of the community Ask about their work - will help you build a management plan Farmers are heavily influenced by family, think about the whole family context. Make the consultation count Top three tips: Keep an open mind, rural health is full of variety. Chat to everybody, especially those who are not directly involved in healthcare. Have a flexible plan for the future, “if the plan is flexible you are always on plan”. Dr Rebecca Orr X: @rebecca0rr Email: [email protected] Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/32577012

Melanie Costas - Rural Mental Health Matters 08/20/2024

Melanie Costas - Rural Mental Health Matters Melanie Costas is the founder of , a social enterprise focused on tackling mental and physical health inequality in the UK. Episode Summary: 00.45 Melanie tells us about her professional background and how she became interested in rural mental health 02.55 Why did she start Rural Mental Health Matters? 06.45 What does Rural Mental Health Matter do? 10.15 What are some of the challenges faced by rural citizens when trying to access mental health support? 14.45 What is it like when people do access local mental health services? 17.00 Is mental health stigma more prevalent in rural areas? 19.10 How much does social isolation contribute to poor mental health? 20.45 Are the mental health needs of the elderly being addressed? 27.15 What could we do to improve mental health access in rural areas? 29.40 Are there any initiatives that she would like to highlight? 32.55 How does disability impact rural citizens? 38.25 Who should be involved in discussions about disability and accessibility? 44.30 How could clinicians better support people with their mental health and disabilities? Key Messages: “Save our mental health” was a campaign in North Dorset to highlight the issue of a lack of mental health services in the area following a review of mental health services in the region. Received 800 responses to the government consultation, as a result a service was put in place in Shaftesbury (North Dorset). Rural Mental Health Matters is representing the rural voice in England and Wales. They would like to have rural community wellbeing centers in larger rural towns and mobile outreach vehicles to go into more rural and remote areas. Currently working on an accreditation for organizations that provide services that are rurally inclusive. Many national organizations currently do not think about rural inclusivity. Rural citizens are less likely to access services as they are further away, they have longer wait times to see GP and there is less opportunity to access support. Cuts to public transport have made services less accessible for many. There is no mandatory mental health support for people following a cancer diagnosis. The referral letter from the GP could include information about mental health support services. Cancer patients living in rural areas can find it very difficult to access mental health support. More focus needed on mental health outreach. Rural patients can be told that the service does not come out that far. Because of the lack of visibility and accessibility of mental health support, rural citizens have expressed that they do not want to burden their family and friends, so they don’t want to talk about it. Carers in rural areas take longer to travel between clients, they can see fewer people and they spend less time with rural clients. This sometimes leads to rural people choosing not to take up those services. Rural areas and local authorities receive less funding to provide care services. Organizations need to focus on how they can be more rurally inclusive. Rural people with disabilities can struggle to access nature, open spaces, and public buildings. There is a lack of disabled parking, and other accessibility support, especially when we know that 1 in 5 people have a disability. Organizations sometimes do not think about disabled access, having an elevator or ramp in the building is often not sufficient. 27% of the population has a visual impairment. More education is needed that develops understanding about the connections between mental and physical health. Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/32575117

Dr Miriam and Malachy Dolan - Dolans Social Farm 08/10/2024

Dr Miriam and Malachy Dolan - Dolans Social Farm Dr Miriam and Malachy Dolan have a social farm in Northern Ireland. We talk about social farming and how it can benefit farmers and rural communities. Episode summary: 00.45 How Miriam became interested in rural medicine 03.15 How Malachy became interested in rural health and social farming 06.30 What is Dolans Social Farm? 10.30 Who visits the farm and what activities do they take part in? 12.50 How do people find out about the farm, how are they referred to the farm? 15.20 What are some of the benefits of social farming? 17.20 What role does social farming play in the wider community health context? 19.20 What kind of training is needed to open a social farm? 23.50 Do GPs know about social farming and do they understand it? 25.30 Are there benefits for farmers that choose to open a social farm? 29.25 Could any farm become a social farm? 35.05 What does a normal day look like at Dolans Social Farm? 39.40 What are the Dolans top tips for starting a social farm? Key messages: Dolans Social Farm is a working farm with cows, pigs and chickens. It is a place where people come, have cups of tea and do some work on the farm. Different people visit the farm, they may have had issues on their life journey, mental health issues or an intellectual disability. They can sometimes feel excluded from normal community life and on the farm they become part of the farm. The social part is key, a farm is a good place to create social inclusion activities. Through the activities needed on a farm people can develop relationships. Visitors to the farm do not have to work if they don’t want to; they can just come and socialize. One of the longest attending visitors comes to the farm and plays the guitar. There are no list of activities as it can depend on events at the farm, the season or the weather. People are referred to the farm through social workers or key workers that work with people with chronic mental health issues or learning disabilities. Family farms already exist and they are assets in rural communities. One of the biggest strengths of social farming is that you don’t have to go out and build or create something new. A farm is a good environment for people that have had experience of life on a farm but are now experiencing something like dementia. The farm helps them feel more settled as they feel that they are in a familiar surrounding while also being able to engage with others. Farm families should already be trained in health and safety as this is relevant for all working farms. Getting involved in social farming focuses the mind on what you should be doing anyway. Social Farms and Gardens is a UK wide charity, representing 3000 members, 450 social/care farms. They offer training and there is a quality assurance system to make sure you are meeting the requirements of the visitors to the farm. GPs want to know that if they signpost someone to a social farm that it is safe for their patient and that the service will be available over time. Priorities for farmers are sustainability, productivity and succession. Farming is a way of life. It is a high pressure profession. Social farming is potentially another source of revenue for the farm. It can help with succession as children can see that the farm is a vibrant, dynamic and social place. Years ago farms were social places, now there is a lot of automation and you might not see anyone during your day. Social farming puts the culture back into agriculture. Many of the visitors to the farm are also farmers. They come to the social farm as they can meet with people who understand the farming lifestyle and the challenges they are facing. Activities on the farm happen from 10am to 3pm, 4 days a week. People are generally very respectful of the farm and personal spaces in the home. Thank you for listening to the ! /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/32501047

Caitriona Crawford - Rural Communities Cancer Project 07/20/2024

Caitriona Crawford - Rural Communities Cancer Project Catriona Crawford is a therapeutic radiographer by training, she is working with the Farming Community Network in Northern Ireland on the Rural Communities Cancer Project. This project partners with Macmillan Cancer Support to raise awareness of the signs and symptoms of cancer, the need for screening, and support that is available following a cancer diagnosis. Episode summary: 00.45 Catriona tells us about her professional background and why how she got interest in rural health 07.00 What is the farming community network? 09.00 What is the rural communities cancer project? 12.00 Why was this project started? 15.30 What barriers exist for cancer care in Northern Ireland? 25.00 What is the project hoping to achieve? 29.25 Who else is getting involved in the project and what kind of partners are they looking for? 34.30 How can people support the project? Key messages: Rural patients (farmers) may choose to stop treatment due to the feeling of isolation and feeling far away from home. Often they have to travel long distances far from support networks, family and friends. The farming community network is a voluntary organization that aims to improve the health and wellbeing of farmers. It is located throughout England and Wales, starting up in Northern Ireland and Scotland. Charity set up for farmers, by farmers. Confidential national helpline for farmers which is available to anyone anywhere in the UK. Rural communities cancer project is a UK wide partnership with UK Macmillan cancer support. Aims to raise awareness of cancer among farming communities and improve the knowledge and understanding of cancer in communities. Macmillan found that rural patients were not uptaking support that they were providing for cancer patients. Farmers can refuse treatment if they are worried about side effects affecting their ability to continue working on their farm. This has led to farmers stopping or not starting cancer treatment resulting in poorer outcomes. Northern Ireland strategy for cancer care highlighted three main barriers to cancer care for rural communities: 1) access to services, 2) access to travel and 3) scheduling of appointment times. Available research and data does not reflect what is seen in practice and what is happening in rural communities. We need better statistics on late cancer presentations based on geography or data on the psychological and financial impact of having to receive treatment far from home. How many people from rural backgrounds are not accessing support services? There is a lack of understanding and awareness of the signs and symptoms of cancer, the project aims to improve this and help people understand what Macmillan cancer support does. It is important to target locations that farmers go to such as sports clubs, schools, and agricultural shows. It is important to understand that these communities engage with people and organizations that they trust. Farming Community Network: Macmillan Cancer Support: Contact Catriona: - Navigating rural health and policy. Thank you for listening to the /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/32037337

13th EURIPA Rural Health Forum Highlights 07/10/2024

Dr Madeleine Muller - RuDASA and Rural Health in South Africa 06/30/2024

Dr Madeleine Muller - RuDASA and Rural Health in South Africa Dr Madeleine Muller is a Family Physician and Senior lecturer at Walter Sisulu University and she serves on the (Rural Doctors Association of Southern Africa) executive committee. Episode summary: 00.50 Dr Muller talks about her journey into rural health 04.15 What were the challenges of working with patients with HIV/AIDS in rural areas? 07.40 What impact does mentoring have on providing services in rural areas? 10.30 How did RuDASA start and how did it develop? 15.00 What tools and resources has RuDASA developed? What is the rural onboarding program? 22.00 What kind of training do medical students receive in South Africa? 27.40 How did RuDASA get more involved in advocacy? 32.00 Have there been issues with supporting advocates? 35.30 Has RuDASA had an impact on recruiting and retaining rural clinicians? 37.30 What has Dr Muller enjoyed most about working in rural health? 38.35 What are Dr Muller’s top three tips for people thinking about a rural health career? Key Messages: Major HIV treatment program rolled out in South Africa - mentoring and training was needed to help implement this program effectively. About 7.5mil people in South Africa are on ARVs, with 70% of the population living in rural areas. All of these people need to travel to clinics to collect their medication every month. Patients need to be monitored for side effects and pick up problems early. Logistical challenges in rural areas that do not have easy access. The more rural the area the more difficult it is to get clinical staff to go there. There are fewer resources and infrastructure. High turnover of young staff coming and going. RuDASA founded in 1996, created as a support network by doctors passionate about rural health. It can be isolating and lonely and this support was important. RuDASA holds an annual conference, doctors gather and talk about what they are up to and the challenges they are facing. Doctors can feel lost and like they do not have the training, backup and support that would be available in a bigger city. Zoom and internet connectivity helped support the development of training and mentoring that was not possible previously. This has made rural health more attractive. RuCASA - rural clinical associates RuNASA - rural nursing Rural Health Alliance launched through Rural Health Advocacy Project, they have joined all the organizations that are passionate about rural health to create one voice for rural health. The National Health Insurance Bill has been passed in South Africa recently, it has been controversial. RuDASA and the Rural Health Advocacy Project have been involved in giving input and applying rural proofing. In South Africa, all young doctors need to spend one year at a rural facility. They are suddenly dealing with a variety of high stakes medical situations with limited resources. RuDASA has developed an onboarding program to help support them in their role. About 50% of the doctors joining the onboarding program are new young doctors, however 50% are more established rural doctors who are using this to update their knowledge and connect with colleagues. South Africa has a 2 year internship, this covers different surgical and obstetric skills. They have been using online tools to link clinicians to specialists. As a group of doctors we know more, on our own we will never know everything. The difference between rural health being somewhere where you can thrive or where you are barely holding on with your finger nails is having support available. This has been the real benefit of RuDASA, no one needs to feel they are going at it alone. Public health systems make “complaining” about things that are not working very difficult. They operate as closed systems and it can be difficult to raise concerns without damaging professional relationships. Rural Health Alliance can give a voice to what they see but it is not one person speaking out leaving them in a vulnerable position. Doctors can get on with their job and the Rural Advocacy Project can write the press statements and give input on public discourse. Healthcare everywhere struggles with human resources, that gap is much bigger in a rural area then an urban area. If two doctors leave a rural area this could represent 25-50% of all the doctors which has a much bigger impact on the provision of healthcare in rural areas. Doctors who are passionate about rural health create the conditions to inspire new clinicians to work and stay in rural areas. RuDASA gathers these passionate people together. To be able to love what you do and thrive in a place you have to feel like it is your calling. Three components - feeling that what you are doing makes a difference, feeling competent at what you do, and feeling appreciated. Contact Dr Muller: - Navigating rural health and policy. Thank you for listening to the /episode/index/show/266bc421-ca82-421e-a797-509482316cde/id/31756021

Rural Road to Health

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