Volume eleven, Issue 2

This multi-stakeholder project in Sub-Saharan Malawi shows what can be done to reach remote and severely underserved populations with just a van, supplies and staff - and good planning.

Bangladesh's remote, Indigenous Mru people live on cliffs and hilltops, in ravines and deep forest - far beyond the reach of the internet or even broadcast radio. It is no surprise then that Mru women's access to antenatal and postnatal care is alarmingly low. What does surprise is the absence of outreach to educate, provide maternal care and to intervene in obstetric emergencies. This study analyses local and systemic factors preventing Mru women from accessing the care they need.

Little is known about "food insecurity" although it is an increasingly important issue among Canadian Arctic communities. This article reports on a unique "Photovoice" study in which images captured by participants assisted in determining factors that influenced the type, quantity and quality of food consumption. The study findings link social determinants of health to cultural values, adding valuable knowledge to our understanding of this significant issue.

Finding an approach to reducing rural suicide can seem an overwhelming task, with the large available literature just the first issue to tackle. If this is a professional concern of yours, look no further than this new literature review, which also offers a unique 'Conceptual model of rural suicide'. The model has the potential to help identify precise points for intervention that are unique to individual rural localities, making this article a 'must-read' for academic researchers, rural service-planners and healthcare staff in any rural location.

Dementia is more prevalent in the Aboriginal population than among other Australians. With low access to and poor quality of care for those living with dementia in rural and remote Aboriginal communities, efforts are urgently needed to improve their situation, and that of their carers. This study makes a start by defining their predicament, and calls for a culturally safe model of dementia care.

Throughout the world, local birthing units are an integral component of primary health care in rural communities. While the transfer of a woman or her newborn to a secondary or tertiary facility for specialist care may be lifesaving, it is also disruptive and stressful. In rural New Zealand, transfer distances may not be great but the transfer is likely to be complicated by adverse terrain or severe weather conditions. In this nation-wide NZ study, the researchers explored the context of and reason for the difficult 'decision to transfer' during labour and birth.

In rural health, priority setting is frequently an interdisciplinary, interagency collaborative process. This review puts into words what many have experienced - that primary care partnership program negotiations can be a complex process, often burdened by the policy shifts of political cycles, and competing values, objectives and priorities among participating agencies. The model presented by these authors captures the range of factors to be considered in such an environment, providing a valuable resource for those in primary health care alliances responsible for doing the work of setting regional priorities.

Does Norway's Indigenous population have greater access to health care than Indigenous peoples in other world regions? This comparative geographical analysis of Norwegian municipal health expenditure offers some surprising findings.

Two case reports of patients with decompression sickness in remote Japan highlight the wider rural health issue of the centralization of health care with air-medical transport support. Is it always the best policy in island emergency medicine - or could there be a better local model? This concise report provides compelling reading - and evidence.

If identifying 'rural-attribute applicants' for admission to medical school was as simple as asking for 'high school graduation location', the rural-urban medical workforce gap would be narrowing. In taking a matrix approach to distinguishing potential students' rural attributes, these authors from Manitoba, Canada, acknowledged that rural-student selection is a more complex exercise, where even some urban-background applicants are considered. The result has been a promising increase in the rural-origin mix of local admissions, and a methodology that promises the same for faculty selection committees in other world regions.

Rural residents want to remain in their home communities for end-of-life care, however providing palliative care in rural areas is an exercise in managing limited infrastructure and resources. This article offers a solution by focusing on community capacity development as the basis for a rural palliative care model. The authors detail the process of model development.

Australian medical students' vary in their motivation to take the University of Adelaide's Global Health course, from wanting to 'make a small difference', to wanting to do 'something different'. What matters most is that students' world views are challenged and altered by this elective that continues to evolve in response to local and global conditions.

The value of undergraduate rural medical placements is now funded and established as a rural workforce strategy. Will the same strategy improve the distribution of dentists to Australian rural areas? This study from New South Wales reviews local and international evidence to date, and adds to it with information from a 2009 study of dental undergraduates - to be continued.

Falls, occupational injuries or MVAs... the statistics speak for those unfortunate enough to suffer a traumatic spinal cord injury in rural India. The authors of this letter argue for pre-hospital care reforms.

Foreshadowing the proposed national career tracking of Australian medical school graduates, this evaluation of compulsory and elective rural medical components at the Australian National University adds to the evidence on undergraduate rural practice intention. Of interest are findings on motivation to select or decline elective year-long rural immersion.

With the incidence of colorectal cancer rising across populations, these authors analysed Australian National Bowel Cancer Screening Program (NBCSP) data for rural and remote South Australia, seeking factors and characteristics that impact on the uptake of voluntary screening. Although the findings are geographically specific, they are essential reading for health planners, policymakers and all others interested in the epidemiology of this high mortality disease.

The real-time video of face-to-face telemedicine consultations can dramatically improve rural and remote patients' access to specialist advice - if local conditions are favourable. This letter from the Philippines reports on the successful use of phone technology as an alternative to the now familiar web-based solutions.

The benefits of breastfeeding have long been established, but breastfeeding prevalence varies and some rural areas continue to lag behind. This article presents a secondary data analysis regarding breastfeeding rates in rural and urban US Applachia, with recommendations for care implications and future research.

What do rural health and social-care staff need to know about delivering services to people with dementia? The workshop participants from remote Scotland in this short report highlighted some universal themes.

Will recent Australian Government initiatives succeed in boosting the medical workforce in underserved rural locations? This short report on the work intentions of the next generation of doctors provides a tentative answer.

In this wide-ranging pilot study, the rural Australian participant pharmacists broached many themes and issues, including privacy concerns, the unique nature of each dispensing environment, the usefulness (or not) of technology, compliance with regulations and staff's embrace of the safety culture. Essential reading for all who have an interest in the safe supply of medicines.

Will the sustainability of New Zealand's rural hospitals be improved by the new (2009) vocational scope of practice in rural hospital medicine? This study establishes the current NZ rural hospital medical workforce as an indispensible baseline for future health service planning.

Is telemental health an appropriate alternative for providing mental health services to isolated First Nations communities? This article discusses a collaborative research project among First Nations communities in Northwestern Ontario, Canada to examine this issue.

The tsunami caused by the 2004 'great Sumatra earthquake' affected rural areas of Thailand and created serious and unexpected health outcomes. Now an earthquake and tsunami of similar magnitude have devastated rural Japan. This letter to the editor suggests Japan can learn from Thai experience in post-disaster rural healthcare management.

This obituary to Ralph McLean describes him as a 'quiet contributor' to rural health.

In a strongly patriarchal society, rural Nigerian mothers experience very high infant mortality. Using data from the 2008 Nigeria Demographic and Health Survey, this study attempts to answer the question, 'Does child survival increase in female-headed households?' In doing so the author negotiates a complex interplay of influential socio-cultural, economic, and geopolitical factors.

What are food deserts? What are their significance for rural families and communities? This article, based on focus groups conducted in Maine, USA, highlights this issue with policy implications for improving nurtition.

Does incomplete cultural adaptation among non-Indigenous health professionals working in Indigenous communities contribute to rural workforce shortages? This comprehensive review of the international literature offers evidence about the impact of culture shock in remote Australia, with potential application to other world regions.

Home-based or hospital-based cardiac rehabilitation? The evidence reported in this systematic review may benefit rural and remote cardiac patients.