Volume four, Issue 2

"Why do we continue to have rural and remote workforce crises? Are we - governments, communities, universities, colleges, professionals - just not trying hard enough? Or perhaps a foundational assumption is flawed." Discussion is a step towards solution. Read Paul Worley's provocative Editorial and add your own thoughts to the discourse.

Do you have difficulty getting city students to choose a rural attachment? One way to make rural undergraduate attachments popular with students is to show that they are good for learning core material. This article provides additional evidence for the effectiveness of rural attachments in nursing, focusing on the way the students successfully engaged with the tension between the hospital's, the university's, the rural community's, and the profession's expectations in the care setting. Such a positive experience will hopefully encourage these students to choose a rural career.

This paper provides evidence that rural and community experiences may have an influence on the plans of junior doctors, as well as on their career choices. The study findings may be transferable to other primary care settings and to places outside Australia, and certainly this article invites further research.

How do you ensure delivery of national priorities when the health service has recently been decentralised? This is an issue that occupies health managers and clinicians in many rural regions in developed countries, but when a developing nation is predominantly rural, with all the communication, workforce and infrastructure challenges this implies, it becomes a national priority. Cambodia's management strategies to increase national immunisation coverage shed important light on this complex issue.

A major report on strategies that rural doctors use to create a sustainable practice has just been released in Australia. This article describes the innovative theoretical and practical approach used to design this research, with a special emphasis on how to engage female rural doctors as participants.

Why do women doctors commence rural practice and why do they stay? These are two very important questions. My interpretation of the data from this qualitative study is that factors intrinsic to the doctor's professional training and aspirations are the most important for recruitment, but factors external to the doctor will determine whether they stay or not. This has extremely important policy implications. See if you interpret the data the same way I have!

This paper addresses an interesting subject related to remote and rural health and it describes a before and after evaluation of a novel method of providing consultant support for acute cases to an island grouping off the Scottish coast. This model would be useful to rural physicians and health planners in other regions and it is expected to open the current dialogue about supported intermediate care for remote and islands areas.

Providing after-hours care to a community, after working a full day, is one of the defining characteristics of rural and remote practice. In addition to issues of remuneration and lifestyle, this study from regional Australia raises the important issue of how models of after-hours care can effect personal and patient safety.

How do we provide a sustainable rural medical workforce? First, we must determine what rural doctors say are the major contributors and threats to the viability of their practice? This survey of over 50% of rural and remote practices in Australia provides this crucial data.

Rural communities often bear the brunt of economic and quality arguments that lead to centralisation of services to a 'regional centre'. This article presents evidence of the inadequacies in such policy implementation, from the perspective of the financial, emotional and physical costs to patients and their families.

Over 40,000 nursing students graduate each year in China. This article, investigating the prevalence of hand dermatitis in rural nursing students, is the first of its kind from China in the English literature.

Do you know the research priorities of the stakeholders in your rural community? Do you want to learn how to find them out? This article clearly describes a useful way to undertake this task, and the research priorities identified may be useful for comparison with your own.

New approaches to rural medical education are underway in Australia as part of a long term national workforce strategy. This article describes an entire clinical curriculum successfully delivered in a single rural community.

The global problem of the HIV/AIDS pandemic is a major issue in the developing world where all who are not infected are personally affected. This introductory article in a series of four is derived from the 'HIV/AIDS in the Developing World workshop' of the 2003 WONCA World Rural Health Congress, Santiago de Compostela, Spain.

"Poverty leads to the spread of HIV/AIDS and, conversely, HIV/AIDS, with its attendant socio-economic impact, leads to poverty. A vicious downward spiral results." Two case stories from Nigeria illustrate this statement in Part II of our series derived from the 'HIV/AIDS in the Developing World Workshop' of the 2003 WONCA World Rural Health Congress, Santiago de Compostela, Spain.

"Prevention versus treatment" - what does this mean in the context of southern Africa where only an estimated 100 000 HIV infected people, out of the 4.1 million who need it, have access to anti-retroviral therapy. Read Part III of our series derived from the 'HIV/AIDS in the Developing World Workshop' of the 2003 WONCA World Rural Health Congress, Santiago de Compostela, Spain, for an effective, equitable discussion.

What does ethics have to offer the tragedy of HIV/AIDS in the developing world? The concluding article in our series derived from the 'HIV/AIDS in the Developing World Workshop' of the 2003 WONCA World Rural Health Congress, Santiago de Compostela, Spain ends with the 'Santiago de Compostela Statement on HIV/AIDS' adopted at the congress.

If you want to know how to involve your community in local medical workforce planning, it is good to learn from other's experiences - especially if those others have been successful over many years. This reflective article from Australia provides poignant insights into the triumphs and tragedies of this important endeavour.

Faced with overwhelming need, and inadequate resources, how do we consider the issue of quality in rural health care? Based on experiences in rural Africa, this article encourages us to see quality improvement as not only desirable, but also achievable.

Current evidence indicates that the Niger Delta region of Nigeria is the worst affected by the HIV/AIDS burden in Nigeria and this has been associated with the region's neglect during the past two decades. Readers may find the authors' recommendations interesting and applicable for their region.

Every profession has its heroes. Rural medicine is no different. This short reflection from a rural doctor son about his rural doctor father is the first article in our new rural health history section.

This email alert for the book review of The Handbook of Rural Medicine in Australia is accompanied by a call for book reviewers. If you are interested in reviewing books for the Journal, please contact ejrh@deakin.edu.au

Are you looking for a practical approach to assist rural communities to improve their health? This preliminary report documents a well designed example from Canada.