Volume ten, Issue 3

The equation's wrong: those who live in rural and remote areas have higher rates of mental illness - but often lack access to specialist mental health services. The Australian Rural Nurses and Midwives identified a need, and took the opportunity to up-skill Australian rural and remote generalists to promote effective management of mental health emergencies locally. This report on the evaluation of the short course 'Managing Mental Health Emergencies' shows how this was done.

Are Australian medical students on rural clinical rotation disadvantaged by being sent in small groups to very small, remote locations? The answer is clear in the qualitative and quantitative evidence from the Rural Clinical School of Western Australia.

Much has been written about traditional midwives, the caregivers of choice or necessity for many birthing women in areas such as rural Western Kenya. This small local study gives voice to traditional midwives about their relationships with skilled (professional) birth attendants. The recommendations reference a wider debate, offer ways to improve the specific issues identified and, ultimately, benefit mothers and their newborn children.

In rural Tanzania, the common belief that medical injections can kill - can be fatal, especially for a child with malaria. However, is it possible that such a commonly held mis-belief has its origin in fact? This clinical case report discusses widespread infection control issues associated with medical injections (including IV therapy) in Tanzania and other parts of Africa. Hopefully, in Tanzania, this will soon be history. The 2010 Tanzanian policy initiative reported may also be transferable to other, similar states and countries.

Amid the global nursing workforce crisis, this Australian review investigated the experience of overseas trained nurses in rural practice. Despite the many well-documented issues related to the international migration of nurses, issues specific to rural practice have been neglected. These authors make a start in their contribution to this important literature.

The association of physical inactivity with chronic disease is not limited to affluent societies. Even in the developing world, the physical activities associated with daily living are diminishing - firewood comes chopped, maize is purchased already ground. In resource-poor rural South Africa, the attitude that organised exercise belongs to a more affluent 'white' lifestyle was challenged by the introduction of a physical activity chronic disease prevention program. The unique insights offered by these authors add to the literature of health promotion.

Studies of rural health professionals have been dominated by centralized urban academic perspectives for decades. Not surprisingly studies about rural practice have focused on areas such as lack of health care resources, lack of professional resources, and isolation. Some of these may represent differences in perception as few studies attempt to capture the nature of practice for rural health professionals. There are indications that some of these perceptions are changing. Even definitions of resources, support, isolation, and appropriate training may be changing due to improvements in communication. Occupational therapists in rural Canadian locations may not consider themselves isolated, may not indicate a lack of professional resources, and may not even believe themselves rural or isolated enough to fit study criteria. New studies are needed as rural and remote locations enjoy improved communication technologies and social support. Some therapists indicated potential mismatches of urban-based support and education. Indeed rural providers have had to retool continuing education to fit rural practice needs. Others listed rural advantages related to autonomy, flexible work schedules, teamwork, and the types of patients and problems encountered. Researchers would do well to assume less based on past studies and to focus more on the current Brave New World.

In common with many of its South Asian neighbours, Nepal's rural population suffer from a maldistribution of the medical workforce. What strategies from the international literature could be applied to this small kingdom - and others like it?

Does the quality of primary care for patients with type 2 diabetes in a rural Italy reach international standards? This small comparative study offers a tentative answer.

Rural medical educational exposure has been associated with an increased interest in pursuing a career as a rural doctor. However, if medical students are conscripted to rural clinical experience, they may view the whole experience negatively and decline graduate rural practice. This Australian multi-university study identifies which factors medical students consider in their decision to attend a rural clinical school - and there are some surprises.

This report of a recent large scale partnership between the Brazilian Ministry of Health and 82 municipal governments identifies factors that facilitated telecardiology solutions for rural and remote patients in Brazil. This is a unique study, not only because it shows the role of local organization and action in facilitating grant funding, but also in reminding government that less organized locations can lose out in grant funded programs.

Enhancing birth outcomes among vulnerable groups in rural and remote areas remains a priority. This retrospective cross-sectional chart review provides useful information about smoking and pregnancy among the Inuit in Nunavut, Canada.

The Editor of this Rural and Remote Health supplement, Campbell Murdoch, says in his Introduction: "...An old adage in the academic world about research is that 'if it hasn't been published, it hasn't been done'. Many things 'get done' in rural and remote medicine but they are usually carried out away from the eyes and ears of others..." These authors presented at the 2009 Annual Scientific Meeting of the Rural Clinical Schools of Western Australia in Bunbury, WA. They have not only written it down, but have also submitted to review and revision. Their work is published in this supplement.

We know there are differences in stroke incidence between rural and urban residents. If so, what can explain this gap? Could it be as simple as the weather? The report of this Japanese cohort study has something interesting to say about the weather and strokes among rural women in Japan.

The 2010 Chalmers Oration was delivered by Dr Tom Calma on 15 August 2010 at Flinders University in Adelaide, South Australia. Dr Calma's presentation concerned the groundbreaking roles that he and the Close the Gap Campaign have played in making a difference to the health of Indigenous Australians, especially those who live in rural and remote Australia. The text of his speech will be required reading for all those who are concerned about the health disadvantage of Indigenous Australians, and to those with an interest in Australian Indigenous health policy.

While biosand water filters are an important public health intervention for the 1 billion people who still lack access to safe drinking water, questions have been raised about their effectiveness. Do those who use the filters understand the concept of recontamination? Is there bias in their survey responses due to fear of losing their filters? Do studies adequately examine important associated outcomes, such as overall health improvement? Does reporting bias influence research approaches, business operations, funding institutions or even government? This study considered some of these important questions when it assessed the performance of existing filters in rural Nicaraguan households.

For almost a decade, Australian medical students have been attending rural clinical schools in a national strategy to boost the diminishing rural medical workforce. Among the now 13 state and territory universities conducting undergraduate- and graduate-entry RCS programs there are distinct curricula. Despite diversity, is the RCS program on track to achieve its goals? In this report on part of the first multi-institution study, the medical students of 6 RCS have their say.

Indigenous Australians have among the highest rates in the world of acute rheumatic fever and rheumatic heart disease. For some, the timing of essential medication can be problematic. This unique study of clients and primary care providers in Central Australia reports on 'The Full Moon Strategy' which uses the natural world as a reminder for monthly penicillin prophylaxis.

Recognised family stresses following the birth of a premature infant can be compounded when rural parents must relocate to be with an infant who neeeds specialized care and life support. This small Australia studies offers a privileged insight into rural parents' experiences, and identifies their coping strategies which are both rually unique and universal.

Back in the 1970s when the Australian rural GP's role was procedurally broad, singer/songwriter Joni Mitchell warned 'you don't know what you've got 'til it's gone'. In the decades that followed, the rural GP's role contracted - or so this research found when it examined the 'the hidden heart' of Australian rural health (the GP proceduralist workforce) and found it to be peril.

Healthcare professionals are always needed in rural areas; recruiting and retaining them is linked to undergraduate clinical rotations. What are the experiences of undergraduate nursing students in rural areas - and their challenges? This literature review provides some answers as well as useful implications and suggestions for educators, faculty and decision-makers.

Consumer-driven community mental health services play an important role in the recovery of rural people with mental illness. At best they capture the essence of a rural community's concern for the wellbeing of its members. They overcome the power differential between health professionals and patients/clients. While information about the benefits and limitations of such services in rural Australia is scarce, this article makes a start by reporting the evaluation of The Station Inc, in South Australia.

Three of Australia's midwifery leaders present their strategies for improving maternal health of Aboriginal women in regional, rural and remote Australia.

Have you ever wondered whether 'social capital' could be applied to the study of rural children? This article from Sweden uses the concept to explore the contribution of 'neighbourhood' to the health and wellbeing of rural pre-teens. The findings reveal unique features of the physical and social landscape that impact on the child's experience of growing up rural.

Pharmacists are a potentially underutilised source of expertise in rural and remote areas. This article from Western Australia describes the additional activities undertaken by pharmacists, asks if these have increased and identifies on-going barriers to expanding services.

A decade after health sector reform, public health services in rural Cambodia remain under-used, despite strategies to improve public sector performance. Qualitative data from TB control health providers in rural Kampong Speu Province is analysed here to identify social and structural barriers and solutions. The findings of this local study offer a potential way forward to providing effective health care to those most in need.

The rate of dementia among older rural and remote Indigenous Australians is much higher than for other Australians, and it is predicted to double in the next 12 years. This Letter reports the research themes and priorities that emerged from the recent workshop 'Recognising and responding to dementia in Indigenous communities', making it a must-read for interested clinicians, researchers and policy-makers.

What does one small rural community have that others do not? This was the question that sparked research into why the West Australian town of Tambellup outperformed others in an early child development index. The important findings of this small study tell the success story of the Tambellup community, whose strengths so effectively promote the wellbeing and healthy development of its children in their crucial early years.

America has entered a 20 year period of rapid increases in the older and oldest and increased access to care for those previously left behind. The likely yield is a record demand for primary and other health care, particularly in primary-care dependent rural areas, despite medical association reports emphasizing the need for more subspecialty and hospital workforce. This timely grassroots study should remind US policy-makers of health workforce priorities in rural areas (and most other US populations) for basic nursing and primary care workforce. The surveyed rural hospital CEOs bring a unique perspective to a now critical issue: the challenges of rural workforce - its varieties, recruitment, retention, shortages and solutions.

The potential of swine flu to spread rapidly challenges rural public health management, where such resource-heavy tasks as contact tracing and case tracking must be spread among available staff. These authors show it can be done effectively. They share the lessons of their successful containment of a recent pandemic A/H1N1/2009 cluster in the remote Scottish Highland.

This article discusses an innovative Rural and Isolated mental health toolkit for use by mental healthcare services throughout rural and isolated Canada. There is much of interest here for those providing similar services in North America.

What are the pain experiences of Indigenous peoples? And are they different from the experience of other groups? This report explores pain experience and related beliefs in the South American Quicha (Inca) peoples.