Volume seven, Issue 2

Rural medical practices are increasingly taking on a major undergraduate teaching role. But could you sustain five students studying for the whole year in your practice? Experience from South Australia suggests you can!

This letter offers an Albanian perspective on the prevalence of type 2 diabetes in a rural population.

This article highlights Australian Aboriginal people's high rates of disease and mortality but low use of prescription medications. Explored as a potential solution to this low access to medication is the expansion of the special S100 scheme of the Australian Pharmaceutical Benefits. Cruicial to including Aboriginal medical services and Aboriginal health workers in this scheme will be the input of pharmacists.

It takes a village to make a healthy community. In Papua New Guinea the sense of belonging to a village is so strong that it remains a part of the fibre of people who have migrated to the capital Port Moresby. This fascinating article describes a novel health promotion program that was initiated by villagers transplanted to the city to keep their rural families and other language group members free of malaria. Do you know of evaluated projects that empowered urban residents to promote health and well-being of rural kin folk? Rural and Remote Health would like to hear about them. Add your comments to the discussion board accessed next to the article. Even better, submit a paper on the topic!

This book review alerts readers to free, useful WHO family planning tools.

India's health system offers a model for postgraduate outreach training.

What are the education, training and support needs of Australian medical graduates and international medical graduates in rural practice. This small study from rural New South Wales has some surprising findings.

Could something as simple as encouraging shoes to be worn more often be a sentinel public health intervention among diabetic patients in poorer rural communities? This article provides thought provoking evidence.

Continuing medical education might be about professional growth but, in retaining rural health professionals, this commentary suggests that addressing needs is more than just addressing CME.

Studies can be used to promote rural health, primary care, or generalism. A much better focus of research is to attempt to understand a number of changes and relationships. In a time of rapid change this can be important. The authors examine changes between 1995 and 2001 to consider the impact of the patient relationship to a physician.

Often students perceive differences in health practice and express themselves quite eloquently. This English medical student, on an elective, discovered the charm and challenges of practising obstetrics in Armidale, a rural town of just over 20,000 population, located in the New England region of northern New South Wales, Australia.

Increasingly health promotion initiatives targeting Aboriginal and Torres Strait Islander people are being evaluated. In this timely paper the authors review 21 recent evaluations. Their findings provide a valuable bluprint for improving the ethical conduct and impact of future evaluations. A "must read" for everyone working with the Indigenous in every nation.

Is a compulsory undergraduate rural attachment a strategic way to encourage interest in rural medical practice? This article from Australia raises some interesting questions.

This article adds to the body of literature that suggests encouraging students to move to a rural area for a 12 month period is a challenge, even in Victoria, Australia, where "rural" is only a 2 hour drive from the heart of Melbourne, the state capital. These results from Melbourne University Rural Clinical School students speak for themselves. A time may come when such studies are not needed, but until then, this article provides valuable insights as to what prospective RCS students are looking for.

How can it be that a national public health intervention can fail to prevent disease in a rural community, despite clear evidence that the community know exactly how to prevent it and appear to have the means to do so? This article from Thailand gives evidence that should not be ignored.

In a world that considers journalism supreme, especially the most abbreviated forms, it is very difficult to understand that there are other approaches to the effective communication of vital information. Approaches that are more likely to lead to better levels of understanding. Ethnography represents such an approach. The work is time-consuming and involves a complete immersion in the subjects and their way of life, while maintaining the ability to observe important differences and similarities. Good ethnography compares and contrasts. Going beyond good ethnography takes great perception, analysis, and writing. Great ethnography brings you into the lives and families and communities of the subjects to understand their experiences and decisions and more. Hopefully the authors of "Seeking serenity: living with HIV/AIDS in rural Western Canada" will expand their works into a book version on a par with "The Spirit Catches You and You Fall Down" by Anne Fadiman, a similar effort highlighting what is often a clash of cultures and beliefs among patients, families, communities, and the medical culture.

One of the barriers to successful implementation of public health initiatives in rural communities is the non-participation of significant groups. This article raises this issue in relation to reproductive health in an Indigenous community in India.

Do you need to influence policy and planning at a national level to increase primary health care activities in your rural communities. This review from Cambodia provides great insights from those who have been intimately involved with this process.

Do you have evidence of disease mongering by vested interests in your rural community? These authors in Nepal raise legitimate concerns for us to consider.

This research from rural Sarawak has found that women have a longer time between onset of symptoms and diagnosis of TB than men. What other factors may be involved? Could this be happenning in your community?

This letter gives an Australian medical student's reflections on his experience with a rural volunteer ambulance service.

The Northern Territory Clinical School based in Darwin is now 10 years old and was precursor to more recently developed Rural Clinical Schools. This paper shows promising evidence that clearly supports the link between rural clinical training and a desire to work rurally. It also demonstrates that graduates from the RCS program need to have the opportunity to work as Interns rurally if the Rural Clinical Schools are going to improve the rural medical workforce in the long term.

Indigenous communities worldwide suffer many health inequities. Is infertility one of them? This short article from India provides further concerning evidence.

Is rural medical practice different to the way city GPs practice? This article provides clear insights from medical students who have observed both.

Dental caries is an important cause and indicator of poor health. This article provides the first data on the difference in prevalence of this condition in Indigenous and non-Indigenous children in a rural South Australian centre.

The pathways to the most needed careers and locations involve many turns and twists and bends. Individual efforts can overcome many, but not all obstacles. Some trails are blazed by those who go before. Others are laid out by those desiring to reach out by building new paths. Distributions of income, education, and training make pathways more challenging and these complexities are multiplied by individual and family situations and by locations. Some individuals, families, and communities have greater levels of organization and some have less. It is a complex interplay of factors at multiple levels.

Research involves more than just statistics, it involves the collected stories of those who share similar pathways to health or to health careers. The language of research may be different, but the stories remain true. Good research captures the stories. Great research translates from those living the pathway to those building pathways.

Most rural practitioners should be familiar with the diagnosis and management of epilepsy. However, abnormal presentations and uncontrolled seizures should alert one to the possibility of unusual causes. This case report describes a patient who presented to a rural hospital in South Africa with a rare brain abnormality.

The Indian Ocean Territories of Australia do not immediately come to mind as important examples of the impact of the lack of workforce and declining services for remote Australians. This novel paper looks at the impact the lack of obstetric services has had on the Christmas and Coco Islands over the last decade. In doing so, Roach et al. provide an article that may be relevant to many other remote communities on mainland Australia.

94% of rural doctors recognise that the provision of and access to continuing medical education in rural areas is a vital factor in the retention of rural doctors and helps with feelings of professional isolation. Dr Colin White and colleagues present new research in their paper.

The current medical workforce in Australian rural emergency departments is a mixture of specialists, vocationally registered GPs, overseas trained doctors and doctors with no particular qualification. This study provides a snapshot of the current workforce. It also presents a range of opinions about options for developing rural emergency doctors in Australia.

In this article Somers et al. try to quantify what makes first year medical students "rural origin" and thus more likely in their future medical careers to work in rural areas. The data presented in this article are even more important to ensure that the outcome of the Australian Government's decision to invest by doubling the number medical student places leads to rural communities having the medical workforce they need in the future.

Interested in how technology can overcome the tyranny of distance? See what's happenning in New Zealand.