Prof Ioanna Tsiligianni - Rural Health in Greece

Prof Ioanna Tsiligianni is a rural doctor,  Professore in General Practice and Public Health at the University of Crete and the President-elect of WONCA Europe.  She talks about her experiences in rural practice in rural Crete, her reserach interests and her plans for her term as WONCA president. Episode Summary: 01.14  Ioanna tells us about her professional background and how she became interested in rural health 03.45  Why was rural practice a great experience? 05.15  How is primary care organized in Greece and the Greek islands? 10.40  What is it like working on an Island like Crete? 12.30  How is island practice different from practice on the mainland? 19.00  What are your research interests? 28.30  What is she hoping to do as president elect and then president of WONCA Europe? 32.20  What are some key challenges for family medicine in Europe? 34.00  What could we do to improve the health of our communities but also our primary care professionals? Key Messages: She has worked in a rural area for 16 years and this was the best experience of her life. She knew everyone in her community very well and it felt like a big family of 2500 people. The feeling of being in a rural area is unique. There are 5000 GPs across Greece and 3000 pulmonologists, there is a large number of specialists, for this reason primary care is undervalued. In rural areas by law all medical graduates have to serve for one year in rural areas, so communities often expect the doctors to leave to go specialize.   Enormous challenges for three main reasons: 1) low numbers of primary care specialists, 2) Greece has huge geographical differences, there are 400 inhabited islands, and 3) in rural areas the majority of the younger population leave for urban areas while the elderly population remains.   On the Greek islands the population triples or quadruples in the summer which impacts availability of medical care for about five months of the year.  On Crete an additional 3 million people arrive during summer.  The population of Crete is 700 000. Much of the day to day work focuses on chronic disease management and public health activities.  Crete has developed a rural research network.  On the islands during the summer you have to deal with permanent inhabitants as well as emergency visits of children and tourists, this means a huge overload for doctors on the islands as no additional capacity is available. On the mainland in rural areas there is a problem of access and fragmentation of care as it is difficult to refer to specialists and a growing elderly population. She was a single GP practice for 16 years so she needed to do everything herself as there were no additional staff. Researched medication use in a rural area which found that patients were hoarding and exchanging medication between themselves.   As a GP in a rural area you have the obligation to raise the issues in scientific articles of the rural patients.  She tries to include the rural patient voice in her work. This is important for influencing policy.   Her research also focuses on respiratory diseases, Greece is the first in Europe in regards to tobacco use with 38% prevalence in the populations.  There are many undiagnosed cases of COPD.   She took the initiative to identify COPD in the community by writing in the local paper about symptoms to look out for and encouraging the local priest to speak about COPD to the community.  This helped to encourage people to come to the doctor and identify COPD earlier so that it can be managed.   As WONCA Europe president-elect she is hoping to improve education and research opportunities for family doctors in Europe.  This will hopefully help family doctors feel less isolated and provide them with easy access to patient education materials.   Family medicine is still not recognized as a specialty in Europe, this needs to be addressed. We need to have the flexibility to spend more or less time with patients depending on what is needed with the patient and family at the centre. You need to listen to your community as each community is unique.     Thank you for listening to the Rural Road to Health! Rural Health Compass