Volume twenty-four, Issue 4

In this Personal View, the author reflects on their first medical posting at a rural health center in northern Pakistan. Their experiences highlight the crucial role of mentorship in the professional development of doctors.

Engaging rural physicians in continuous quality improvement (CQI) activities is important, but can be challenging. This study explores and shares enablers and barriers to CQI participation by rural physicians in the province of British Columbia, Canada.

Indigenous organizations and community health directors consistently highlight the lack of comprehensive data and the urgent requirement for measures to bridge the gap in health assessment and health disparities among Indigenous youth. The Aaniish Naa Gegii: Child Health and Well-being Measure (ACHWM) was co-created with and for Indigenous children from the Wiikwemkoong Unceded Territory in northern Ontario. The measure aims to provide a holistic perspective on wellbeing that goes beyond health and considers the values and beliefs of Indigenous peoples. While many First Nations communities in Canada share similar general concepts of holistic health, there are still important cultural distinctions within each community. This Original Research article reports on a study that assessed the cultural relevance of the ACHWM for children of the Wolastoqiyik community.

The primary care team at the local GP clinic serves as a first point of healthcare contact for rural communities in Ireland, but changes in financial supports to GP practices in 2010, and a history of structural urbanism, resulted in many rural general practices struggling for viability. This Policy Report presents a brief account of advocacy led by rural GPs and their communities in Ireland, and the political and policy implications of their efforts.

The early consideration of parechovirus in infants presenting with undifferentiated abdominal illness atypical for sepsis or surgical cause may facilitate supportive management in some rural hospital contexts without need for transfer. This Clinical Case Report describes a rare presentation of parechovirus infection and its management in an 11-day-old infant in an Australian rural hospital.

In Canada, an estimated 20% of the population experiences a mental health and/or substance use (MHSU) disorder, such as generalized anxiety disorder or major depressive disorder, in any one year. People living in rural regions tend to have disproportionately higher rates of mental health challenges, poorer mental health outcomes and a higher risk of a fatal toxic drug poisoning compared with urban areas. Compounding these inequities, MHSU services may be absent, difficult to access, or inadequate in rural areas. Although literature reviews have been conducted on rural nursing (ie. on rural health nursing research, rural continuing nursing education, and evidence-based practice and rural nursing), less attention has been paid to rural MHSU nursing. This Scoping Review examines the rural MHSU nursing literature.

Clinical guidelines recommend pulmonary rehabilitation for the management of the long-term effects of critical illness associated with COVID-19. It has been reported that supervised pulmonary rehabilitation programs improve lung function, exercise capacity, and exertional dyspnea in patients with severe (requiring hospital treatment) or critical (requiring admission to an intensive care unit and even ventilation) COVID-19. Although in-person rehabilitation services proved difficult to provide during the pandemic owing to health system overload, telerehabilitation emerged as having great potential to stop this gap. The lessons about telerehabilitation learned during the COVID-19 pandemic are also likely to benefit rural patients, for whom in-patient rehabilitation can also be challenging owing to inequities in healthcare access because of workforce maldistribution and distances to clinics. This Original Research article compares the long-term results of different types of telerehabilitation programs on hemodynamic and clinical parameters associated with exertion and physical functions in discharged COVID-19 patients.

Access to care is an ongoing challenge for many Indigenous peoples living in remote communities. Equitable health care for Indigenous people must be culturally safe and trauma informed, while also being accessible. This study uses a narrative approach to investigate First Nations peoples’ perspectives on the use of virtual care and the development of a therapeutic relationship in the context of virtual physiotherapy. This article offers insight into how to deliver care virtually while ensuring cultural safety, and working with the limitations of virtual care.

During pregnancy, the risk of iron deficiency increases because of the elevated demand for iron in the mother for the formation of red blood cells, and placenta and fetus development. In Indonesia in 2018, 84.6% of pregnant women aged 15–24 years experienced pregnancy anaemia. Following global recommendations, the Indonesian government has made several efforts to reduce iron deficiency anaemia in pregnancy. One of these is providing pregnant women with daily iron–folic acid supplementation (IFAS) during antenatal care visits, though the success of this program has been challenged by a lack of coverage, various brands in which iron–folic acid content does not meet the standard, consumption that does not start early in pregnancy, low quality of IFAS education and lack of records. There is also some evidence that IFAS can be influenced by maternal education and household wealth. This Original Research study investigates social determinants and socioeconomic inequality in adherence to antenatal IFAS in rural and urban settings in Indonesia. Findings from this study may contribute to formulating appropriate policies and interventions to enhance antenatal IFAS adherence, and therefore better maternal nutrition and health outcomes.

The WHO defines traditional, complementary and integrative medicines as a broad set of healthcare practices from different cultures used for health promotion, prevention and recovery. In the Brazilian Amazon, traditional healing practices, often using medicinal plants, are common for solving physical, spiritual and magical or religious problems. Better understanding of traditional medicine can contribute to the improvement of health care of traditional peoples and communities, and subsidize the practice of professionals who work mainly in the context of primary care and other levels of health care. This Review article identifies, maps and synthesizes scientific evidence on the use of traditional medicine as therapeutic resources when used by traditional communities of the Brazilian Amazon.

A OMS define as medicinais tradicionais, complementares e integrativas como um amplo conjunto de práticas de diferentes culturas usadas para promoção, prevenção e recuperação da saúde. Na Amazônia brasileira, as práticas tradicionais comumente utilizam plantas medicinais para resolução de problemas físicos, espirituais e mágicos ou religiosos. A melhor compreensão da medicina tradicional pode contribuir para a melhora do cuidado em saúde de comunidades tradicionais e subsidiar a prática de profissionais que trabalham principalmente no contexto da atenção primária e de outros níveis de atenção à saúde. Este artigo de revisão identifica, mapeia e sintetiza a evidência científica sobre o uso da medicina tradicional como recurso terapêutico utilizado por comunidades tradicionais da Amazônia brasileira.

The WHO defines traditional, complementary and integrative medicines as a broad set of healthcare practices from different cultures used for health promotion, prevention and recovery. In the Brazilian Amazon, traditional healing practices, often using medicinal plants, are common for solving physical, spiritual and magical or religious problems. Better understanding of traditional medicine can contribute to the improvement of health care of traditional peoples and communities, and subsidize the practice of professionals who work mainly in the context of primary care and other levels of health care. This Review article identifies, maps and synthesizes scientific evidence on the use of traditional medicine as therapeutic resources when used by traditional communities of the Brazilian Amazon.

This statement, written by delegates at the 2023 'Are You Remotely Interested' Remote Health Conference in Queensland, Australia, is an urgent call for recognition and support for rural generalism, including specific training and continuing professional development through interprofessional education strategies located in rural and remote communities.

Abortion is not routinely funded, provided or monitored by Australia’s public health system. Less than 10% of GPs in 2021 had undertaken the mandatory training to prescribe for medical abortion and most procedural abortion services are delivered by independent providers at considerable out-of-pocket cost to the consumer. GPs that are conscientious objectors to providing abortion services are legally obliged to refer to other available services but, for rural GPs, the absence of feasible referral pathways means this obligation can easily remain unfulfilled. This Original Research study investigates the experiences of rural primary care providers who become the ‘first point of contact’ for women with unintended pregnancy and, irrespective of their knowledge, interest or expertise in abortion provision, are charged with the task of ensuring abortion-seekers in their rural communities reach the services they need in an unaccommodating health system.

The COVID-19 pandemic began in 2020 and caused major disruptions to social activities, education, employment, and healthcare delivery. A concurrent ‘infodemic’ of misinformation (unintentionally false information) and disinformation (deliberately misleading information) about COVID-19 was also widespread. To help prepare for future infodemics, this Original Research article examines associations of health literacy with impacts from the COVID-19 pandemic among a diverse sample of adults in Northern Arizona, USA.

General practice (GP) plays a vital role in delivering improved community health outcomes, particularly in rural communities, where geographical barriers, lack of transport and increased distances to healthcare services lead to poorer health outcomes for rural dwellers compared with people living in urban areas. In Ireland, approximately 1 in 3 people live in rural areas and only 7% of rural people live within walking distance of the nearest GP clinic. It has been forecasted that by 2031, there will be a 46% increase in demand for primary care services across Ireland but the number of rural Irish GPs has been decreasing over the past two decades. This Original Research study explores the distribution of GP clinics among rural and urban populations in the Mid-West of Ireland and the impact on new travel distances if GP clinics were individually closed across the region.

Low back pain is an international public health issue affecting over half a billion people worldwide, and the burden of low-back-pain-related disability is increasing, particularly in low- and middle-income countries. A recent quantitative study in Suriname provided the first insights into the burden of musculoskeletal diseases in the country and found that low back pain is highly prevalent. Indigenous Peoples face numerous and unique barriers in seeking care for their low back pain. This Original Research article presents the results of a qualitative study that aimed to better understand the experiences of low back pain and care-seeking among Indigenous Peoples in Suriname by using a culturally relevant approach supported by the local traditional authority. The research was carried out in Galibi, a remote Kalinya Indigenous village in the north-east of Suriname.

A dor lombar é uma questão de saúde pública internacional que afeta cerca de 500 milhões de pessoas ao redor do mundo, e cuja carga de incapacidade está aumentando, particularmente em países de renda média e baixa. Um recente estudo quantitativo no Suriname forneceu as primeiras informações sobre a carga das doenças musculoesqueléticas no país e encontrou que a dor lombar é altamente prevalente. Indígenas se deparam com barreiras numerosas e únicas na procura por cuidado para a dor lombar. Este artigo original apresenta os resultados de um estudo qualitativo que objetivou uma melhor compreensão sobre as experiências de dor lombar e procura por cuidados entre indígenas do Suriname, utilizando uma abordagem qualitativa relevante apoiada pela autoridade tradicional local. A pesquisa foi realizada em Galibe, uma remota aldeia Kalinya no nordeste do Suriname.

El dolor lumbar es un problema de salud pública internacional que afecta a más de 500 millones de personas en todo el mundo, y la carga de discapacidad relacionada con el dolor lumbar está aumentando, en particular en los países de ingresos bajos y medios. Un estudio cuantitativo reciente en Surinam proporcionó los primeros conocimientos sobre la carga de enfermedad musculoesquelética en el país y descubrió que el dolor lumbar es muy prevalente. Los pueblos indígenas enfrentan numerosas y singulares barreras a la hora de buscar atención médica para su dolor lumbar. Este artículo de investigación original presenta los resultados de un estudio cualitativo que tuvo como objetivo comprender mejor las experiencias del dolor lumbar y la búsqueda de atención médica entre los pueblos indígenas de Surinam mediante el uso de un enfoque culturalmente relevante respaldado por la autoridad ancestral local. La investigación se llevó a cabo en Galibi, en una aldea indígena remota Kalinya en el noreste de Surinam.

Enduring inequities in rural healthcare provision, underpinned by an inadequately sized and fit-for-purpose workforce, are well known to those invested in or tasked with supporting the sustainability of rural communities. In this Commentary, the authors discuss what the rural GP shortage discourse has meant for bottom-up, community development approaches to strengthening the rural health workforce and top-down supports for improving rural healthcare quality. They explore how well the frame of the rural GP shortage marries with rural residents’ current health and social care needs, and the circumstances of rural GPs. They propose implementing several multi-level actions to further stimulate and promote a much-needed shift in discourse and power to alter investment and lead a future re-imagining of the rural health workforce.

Human papillomavirus (HPV), which can cause cancer, is the most prevalent sexually transmitted infection in the USA. Before the global COVID-19 pandemic disrupted cancer prevention and control systems, HPV-associated cancer incidence was rising in rural USA. However, understanding the burden of HPV-associated cancer in rural areas has been complicated by two factors: (1) ignoring heterogeneity within non-metropolitan populations, which might mask the excessive burden in small, rural communities; and (2) not accounting for mortality where HPV-associated cancer was not the underlying cause of death but a contributing factor. This Research Letter provides a clearer picture by analyzing the latest Surveillance, Epidemiological, End Results (SEER) incidence and incidence-based mortality data.

The use of community paramedics in rural communities has been expanded within recent years; however, little is known of whether community paramedics are a valid option in reducing hospitalization for specific procedures. This study assesses reduction of hospitalization for patients who underwent a coronary artery bypass grafting procedure.

Limited access to psychological treatment is a pressing problem in the United States, especially in more rural areas. One potentially underutilized resource is informal care from friends and family members. These authors report on a pilot test of the Friends and Family for Mental Health Program, a mental health skills program developed to enhance informal care and reduce psychological symptoms among informal caregivers.

Despite educational and policy efforts, the projected healthcare professional shortage in the USA is expected to increase in the coming years, with rural and underserved communities among those that will be most affected. For newly graduated clinicians, the juncture between the conclusion of formal training and initial practice in a rural community is a critical time that influences retention. Particular challenges for new healthcare professionals in rural areas include isolation, inexperience, purpose, and community integration. To that end, Mountain Area Health Education Center developed a Rural Fellowship program with the intention of facilitating both the placement and continued development of recent graduates from family medicine and one clinical pharmacy residency program in rural western North Carolina. This Original Research article outlines promising results from the Rural Fellowship program.

Australia’s Great Barrier Reef (GBR), stretching 2300 km along the Queensland coast, has millions of visitors per year. Medical emergencies are not uncommon among visitors to the GBR, and patients often require aeromedical retrieval due to their remote location. Little is known about the clinical characteristics of these patients. This Short Communication describes the characteristics and outcomes of patients experiencing cardiac conditions who were retrieved to Cairns Hospital from locations along the northern GBR.