Volume 4

Good health for those in rural communities is a goal for those concerned with rural and remote health, the world over. This Editorial contextualises a recently released, Australian collaborative 10-point plan that provides strategies for rural health. Are the strategies appropriate for your community - or does international rural health demand other priorities?

"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.

How do you feel when battling to re-orient metrocentric health and education systems or attempting to get a fair share of resources for rural communities? Frustrated yes, but alone, never! Read this perspective from South America to encourage you in your work, wherever you are.

What a year! RRH is growing exponentially, has MEDLINE recognition and a new home. This editorial bookmarks these achievements with the challenges that are still ahead.

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.

So....your rural health professionals have discovered they have an educational need for which no existing program exists. This article describes an Australian response to this problem in the area of obstetric ultrasound.

Do you ever find yourself in the position of needing to refer a patient but there is no-one in your local area for you to refer them to? This article investigates this common dilemma for rural health professionals from the perspective of community-based nurses in rural Australia.

The barrage of information assaulting us from all directions is enormous. However most of it has very little to do with day to day living. Pain is a different matter. All of us self-treat in a variety of ways. This study compares rural communities in Canada and the US. Health providers in both countries could improve patient education and help patients when dealing with perhaps a most common ailment.

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.

Is virtual health care the way forward for rural communities? This question often polarises communities, policy makers and health professionals alike. This article outlines an interesting experiment in south-east Australia. What do you think?

Participating in a pioneering rural educational program can be exciting, challenging, and motivating. It can also create significant anxiety. This frank exploratory study provides useful insights to rural curriculum innovators.

Violence against women by their husbands is a worldwide horror that unfortunately does not spare rural communities. This article provides confronting evidence from rural Indian villages of the extent of this reality.

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.

We are all aware of the impact of good nutrition on health. But what if healthy food is not available, or is too expensive, in your rural community? This article provides evidence that can inform our responses.

Effective emergency services are a high priority in our rural communities. They rely on the different professions and local and regional organisations all working together. What happens when they are threatened? This article presents a positive case-report arising out of just this scenario.

Rural health workforce planning requires accurate data. This Australian study has attempted to provide just that in relation to undergraduate nursing students in rural and remote campuses. It seems so simple that you wonder why it wasn't done before!

What priorities do practising rural doctors place on the initiatives in place to improve recruitment and retention? This evidence from Australia informs this crucial international policy debate.

Could a diet rich in fish oil protect indigenous people in rural communities from the complications of diabetes? This is one of the hypotheses that results from this simple study by rural doctors in Canada.

This paper from Ireland attempts to evaluate patient satisfaction with general practice out of hours cooperatives in a rural district. It also investigates the impact of rurality on patient satisfaction. Health planners, rural practitioners and researchers from other European countries could learn reading this interesting study.

There are few comparision studies regarding training site location. The differences reported by medical students may be of great interest to medical educators who are considering a number of challenges, particularly how to maintain procedural intensity and training relevance.

The population across the developed world is rapidly ageing, especially in rural areas, so strategies to address medicines and the elderly are particularly relevant. This Australian study assessed the impact of a GP and pharmacist medication review on health outcomes such as medication-related hospital admissions in ambulant elderly, and on quality of life. There may be something here for elderly people in your area.

Medical education often fails to meet the needs of certain populations. Coordinated efforts involving communities, government and medical schools offer promise. This article describes vertical integration efforts involving a medical school and a region in Australia. Interestingly there are benefits that travel the pipeline in both directions.

Living with chronic pain appears to be a common experience for a rural indigenous population in Australia. Read this article to find out why, and what may be done about it.

Are your hospitals and specialist services overloaded? Perhaps your health insurance system is contributing to this problem. This study from rural Iran has lessons for us all.

Patients in rural communities need to find help somewhere. If there are no vacancies at the local doctor's clinic, they often present at the Emergency Room of the local hospital, only to be seen eventually by the same doctor who was too busy to see them at the clinic! Meanwhile, emergency care is compromised. This article presents new evidence from Canada on the prevalence and causes of this problem and suggests practical solutions that could apply in many rural settings around the globe.

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.

The interplay between "traditional" and "modern" expectations in childbirth is complex. This study from rural Vietnam identifies some of the crucial issues that many rural regions need to face in this difficult area.

We know that asthma is a serious and common affliction. We know that indigenous communities in the developed world have very concerning health indices. So, put them together, and what do you get? The answer is - we dont' really know! This paper reviews the available evidence in the Australian context and calls for the urgent development of studies of high methodological quality and culturally appropriate design.

When we debate rural health policy internationally, it is helpful if we can first agree on the definitions of the terms we are using. As well as critically appraising a variety of theoretical health frameworks from a rural perspective, this article provides a useful summary of many of the terms used by rural health policy makers.

Rural communities have a different epidemiological profile from urban communities. This fact impacts the cost-effectiveness of public health strategies. This article clearly demonstrates this principle in relation to testing for strongyloides in rural indigenous communities in Australia.

Are you tired of 'best practice guidelines' being produced that rely on technology and resources unavailable in your rural community? This clinical review provides evidence-based guidance on the treatment of 'tennis elbow' that is entirely appropriate for rural clinicians.

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.

Rural health research is on the agenda in many countries. In Canada, where almost one-third of the population live in rural, remote or northern regions, rural health research opportunities have been surveyed. This article gives an overview of the results, including the strengths of Canada's universities in building capacity - and the gaps that still exist. Does this echo the situation in your part of the world?

Rural health professionals often have to find ways of bridging different cultural perspectives in order to improve health outcomes. This interesting article shows how sport was chosen as an effective link to enable treatment of chronic musculoskeletal pain in an Australian Indigenous community.

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.

Have you ever noticed how sometimes small rural communities can implement health strategies that much larger centres find too complex? This article neatly describes how a local rural doctor led his community to effectively address the morbidity from falls in their elderly residents. Perhaps you have a similar success story to share?

The healthcare problems of Indigenous communities sometimes appear too great to face, especially when added to geographic isolation. Yet face them we must! This report describes a collaborative approach to eyecare for rural Australian Aboriginal people in New South Wales, that shows how it can be done. It may help others find solutions in their own regions and fields of expertise.

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.

How do internationally promoted models of care, not necessarily designed by or for rural, remote or indigenous communities, translate to our specific contexts? A recent conference tried to address this issue in relation to community based rehabilitation. Would their conclusions be similar to yours?

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.

Rural health is definitely on the political agenda in Canada. What can the international community learn from an analysis of their approach to sustainable progress? What may Canadians need to rethink? This article presents a well substantiated contribution to these important debates.

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 Letter to the Editor reports on a consensus reached in a small workshop held at the WONCA Santiago 2003 conference. The worshop looked at some key issues concerning teamwork in a rural setting. The Letter shares some important views on a subject which requires multiple answers across the different health systems.

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

Have a read of this book review and then hopefully the book itself if you want to be challenged, provoked and stimulated. It will certainly take you out of the everyday norm .....

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.

Does educating medical students in rural communities increase the number of junior doctors working in those same communities? This preliminary report provides further evidence that the answer is - yes!

January Journal Search presents a selection of rural health related articles on open access at Biomed Central; Rural and Remote Health hopes users will find Biomed Central a useful source of information.