Volume 3

Whether you are about to have summer or winter holidays in your rural community, there are perils for travellers that resident rural health professionals need to know how to deal with. This month's Journal search looks at 2003 publications from around the globe on such issues as snake bite, road trauma, alpine trauma, alcohol use and jellyfish stings. Happy browsing and merry Christmas!

Working as a health professional in a rural community is a priviledge, but also carries certain risks. This article reveals that in Japan, low back pain is too common a problem in those at the frontline of rural healthcare, rural nurses.

Have you ever developed a great health promotion program that targets a very important need in your rural community, but when you implemented the program it had no effect? Why does this frustratingly happen again and again? This personal view from Nepal provides helpful insights from just such an experience.

At last, an academic rural health journal for Europe! This joint Editorial by Paul Worley and Christos Lionis announces an initiative that will be of value to isolated and rural practitioners across Europe, as well as to RRH users around the globe.

The delivery of allied health services to remote areas is problematic. Not only is it difficult to recruit and retain an appropriate staff mix, but communities often have unique requirements. A multi-agency initiative in Queensland, Australia, tackled the issue systematically. This unique study provides a model for service delivery on which remote and rural communities in any world region can base their own initiative.

Journal Search brings Rural and Remote Health users information about relevant recent publications. This month's highlights include contents and recent publications in rural health/ primary healthcare journals, worldwide.

Read this new research and listen to the clear voices of rural Australian youth as they reveal their key health concerns. The authors also make some policy relevant analyses, especially in regard to the access issues facing rural youth.

If mid-life women are under-represented in the literature, then rural mid-life women are rarely allowed a voice. Put aside your daily concerns for a while and listen to the wisdom in this accessible qualitative study from Canada. What the participants tell us about their lives should be heard by all social researchers.

Homophobia and discrimination, social isolation, the absence of appropriate services or information... these are just some of issues that prompted this author to explore the troubling hypothetical association between same-sex attraction and rural youth suicide.

A successful rural medical education model may receive much attention, but it takes more than a few individuals each year to impact on regions or nations. Once the original is replicated successfully, not only will others join in, but policies can encourage development of such programs. This article describes the replication process and is useful for those involved in development and evaluation of rural experiences.

Journal Search brings Rural and Remote Health users a collection of abstracts from recent MEDLINE-listed articles. This month highlights recent publications with title key words that included rural and general practitioner, nurse or practitioners.

How does being 'rural' affect people's preceptions of health? This small study provides some useful clues that could inform further useful research. Do the findings agree with views in your part of the world?

Journal Search brings Rural and Remote Health users information about relevant recent articles, including abstracts. This month's highlights include recent publications in the rural health journals on the subjects of rural health services, health economics and medical education.

Rural practice is a team effort. If one element of the team is missing, all are under strain. Whilst much work has addressed the maldistribution of the medical and nursing workforces, less has been published on the allied health disciplines. This article outlines the benefits of a pro-active approach in the discipline of podiatry.

Few would doubt that enabling post-graduate doctors to train in remote locations is crucial to a medium-term rural medical workforce strategy. Yet, to be effective, this education must be a positive experience for both trainee and trainer. This commentary accompanies Susan Wearne's article. Together, they explore the crucial issues of practice workload, population health, gender, teaching time and learning styles that have arisen in Central Australia, 1500km from the nearest capital city.

Few would doubt that enabling post-graduate doctors to train in remote locations is crucial to a medium-term rural medical workforce strategy. Yet, to be effective, this education must be a positive experience for both trainee and trainer. This article, and its accompaning commentary, explore the crucial issues of practice workload, population health, gender, teaching time and learning styles that have arisen in Central Australia, 1500km from the nearest capital city.

High quality undergraduate education in rural hospitals is a crucial element of the rural workforce and quality improvement strategies of many countries. But how do good clinicians decide whether a student is competent or not? This article explores this issue from the perspective of rural nurses.

When universities decide to move substantial medical education programs out of urban tertiary centres and into rural community settings, new methods need to be found that take advantage of the unique characteristics of the new setting. This article describes one such approach in rural Australia. Could this be useful where you live?

Sometimes, endemic infectious diseases can seem overwhelming, and attempts to control them frustrating and exhausting. Yet population approaches to such major health problems, for example using insecticide coated nets for malaria, are essential to improving the health of rural and remote communities throughout the world. This article analyses the issues faced in Africa in a major initiative to control the scourge of onchocerciasis. Maybe there are lessons for us all from this experience.

Journal Search brings Rural and Remote Health users information about relevant recent articles, including abstracts. This month's highlights include recent publications from the rural health journals about recruitment and retention of medical staff, and rural clinical material.

You may have heard that the health status of Australian Aboriginal and Torres Strait Islander people is an issue of international concern. But what do you know about indigenous men's health? Probably not much, as there is very little published in this field. This editorial sets the scene for a research and education strategy to improve the health of Aboriginal and Torres Straight Islander men.

Do you work in a small rural hospital? Have you ever thought of developing your own local continuing education program instead of going to city-based functions? This short article from South Africa presents some simple and practical advice on how you can go about it and reap the rewards.

Most readers of this journal would regard themselves as advocates for rural health. But do we all mean the same thing when we refer to 'rural'. This article provides a South African perspective to this debate. We would be interested to hear how other countries define rural in the context of health.

How do rural health services develop systems to address chronic diseases? This paper provides a case-study of an attempt by a rural Australian region to do this in relation to asthma. What does your region do? RRH would be interested to hear.

Have you recently been asked to have a student in your rural practice? Have you felt guilty if you refused? In this personal view, experience rural supervisor, Prof Ian Couper, gives a realistic perspective on having students in your rural practice, and offers some thoughtful guidelines for those considering giving something back to the profession, and helping the future rural workforce, through having a student visit.

Regionalisation of health services with increased autonomy to local decision makers is a common policy direction internationally that directly effects rural clinicians and communities. Does it work? This article provides evidence to help answer this question from a decade of experience in the Philippines.

Journal Search brings Rural and Remote Health users a selection of relevant recent abstracts from MEDLINE. This month's themes are rural: medical workforce and training; nutrition in maternal and child health; obstetrics; and public health.

Have you ever been given responsibility to upgrade a significant web-based database? Its not an easy task. This article describes how a group from Australia undertook this task for two rural research and education databases. They also show how common web-searching techniques can miss a significant amount of relevant rural literature. If you know of other rural databases that may help our readers, please let us know.

Does exposing medical students to rural practice alter their career preferences? Does it help if the student has lived in rural areas previously? Read this useful review to see these authors' considered conclusions.

Is rural workforce policy in your country evidence-based? How can we collect the necessary evidence? Published to co-incide with the pulication of a narrative review of the impact of rural placements on the rural medical workforce, this commentary challenges us to examine the current status of rural workforce policy decision making and provides suggestions on a way forward to meet the challenge.

Having difficulty attracting a good doctor to your community? Perhaps appropriate accomodation is what is missing. This article gives an African perspective on this important recruitment issue. How does this work where you live? We would be interested in views from other regions of the world. Start a thread in the Discussion Forum on the RRH site, or contact us at ejrh@deakin.edu.au

It is said that a health service is the 'heart' of a rural community. This paper demonstrates that it is also a major economic engine, and provides a useful way to quantify this - very useful for rural advocates to use in arguing their case to government.

As both an exporter and importer in the international trade of qualified doctors, South Africa finds itself in an ethical, financial, and health outcome dilemma. And, as usual, the impact of this is greatest in the rural communities. Read the article and see if your view on this controversial subject stays the same.

Accessing health services in a rural community can be difficult enough, without the addition of language and cultural barriers. This article examines the health service utilisation of women born in the Philippines, but now living in rural Queensland, and finds that, whilst some of their difficulties are frustratingly predictable, others may not be obvious without taking the time to ask.

Are you involved in implementing a new health initiative in a rural community and are struggling to find a useful way to evaluate it? This article describes an innovative and useful method of using the literature to develop a simple filter to sift through the mountains of data collected by project managers. The filter is then used in the authors' project to distill some critical issues for successful implementation of rural health service projects. See if it can help you.

Have you ever been challenged by someone who says that there realy isn't any difference between rural and urban health? Perhaps their perspective is more framed by their 'holidays in the countryside' than by the facts of day to day rural life. This evidence from Pakistan on the high level of stunting, wasting and underweight amongst rural children, especially girls, is extremely confronting. It reminds us that there is still a lot of work for us all to overcome the underlying causes of health disadvantage in our rural communities.

The mad dash to hospital of a terrified husband with his wife in labour is the Hollywood-style example of an issue that is important for all rural health professionals. Implicit in the primary health care model, and common knowledge to rural health professionals, is that effective approaches to health must be inter-sectoral. This article from South Africa looks at the transport issues for both patients and staff that must be considered if we want to create effective and accessible rural health care systems.

Do you have difficulty staffing your rural hospital? So do many health services in South Africa. Read this article to see what they have done about it and what one author sees as a sustainable way forward.

Have you been frustrated when a patient refuses to comply with the treatment you have prescribed and you see their illness progressing un-necessarily? Have you blamed yourself, and your lack of time to properly explain the importance of your treatment plan? This article proposes a new and helpful way to look at compliance as a symptom of a far greater systemic dysjunction, especially in cross-cultural contexts that are common to remote practitioners. It will make you think!

Journal Search brings Rural and Remote Health users a selection of relevant recent abstracts from MEDLINE. This month's themes are rural: cardiac management, and disease and disability in developing nations.

Journal Search brings Rural and Remote Health users a selection of relevant recent abstracts from MEDLINE. This month's themes are rural: occupational health, public health and toxicology.

Rural doctors throughout the world provide highly valued clinical supervision to medical students. But is the quality consistent, and can it be improved? Read this article to hear how a small medical school has addressed these issues by evaluating its placements (survey tool included), then understanding and addressing the educational needs of its rural teachers.

Do you live or work in an area where strongyloidiasis is hyperendemic? If so, this clear, concise and practical article is for you. If you are interested in how to prevent a seemingly shortlived infection from representing much later as a fatal disseminated sepsis, then read this article to see what action is being called for by the Indigenous communities in northern Australia.

Do you sometimes find city dwellers minimising the problems faced by rural communities? Isn't life in rural areas meant to have some romantic 'natural' appeal? This article presents further confronting evidence of long-standing rural-urban health inequalities, in this case, maternal and infant health in the Indian state of Andhra Pradesh.

If you manage rural placements for health professional courses, I'm sure you have had difficulty getting the correct match between student and rural community. A poor match can result in a student who is less likely to see rural practice as a career option, and a rural community that is less likely to take future students. This article details the development of an innovative web-based tool that may help in this important work.

Becoming a larger fish in a smaller pond is an analogy often used of rural living. However, not everyone living in a rural community is involved and active. This Australian research finds that those who are involved report better health as well. This has interesting public health policy ramifications. Think of how your friends and colleagues in your community would rate. Are there systemic barriers to participation in rural communities? How can we help those who are not involved? Read the article and see what conclusions you come to.

Are there practical and appropriate ways to identify and then treat the burden of chronic disease in remote indigenous communities. This research, using point-of-care pathology testing for renal disease suggests that the answer is YES!