Rural Road to Health

Dr Daniel James is a rural GP in Suffolk and one of the creators of the Rural Minds Project.  Episode summary: 00.59  Daniel tells us about his professional background and how he became interested rural health 03.03  What is the Rural Minds Project? 06.08  How did different collaborators come together to work on the project? 08.15  What were they hoping to achieve with the Rural Minds project? 11.30  What do we know about farmers' mental health?  What are some key facts we should know? 16.10  Why did they decide to use virtual reality and how is it being used? 19.15  What is the scenario like and how long does it take to go through it? 23.00  What challenges have there been during development? 25.45  What feedback have they received on the project? 27.00  Where does he see the project going in the future?   Key messages: There are hidden risks in rural populations that are not explored at medical school. Rural Minds is an education project that uses immersive virtual reality to help medical professionals understand farming life and the mental health challenges of farmers. The project draws on real life experiences. There are increased risks of mental health issues and suicide within farming communites. They collaborated with the farming community to film scenarios and develop the project which helped to keep scenarios realistic. The first goal was to develop a tool for clinicians to help them develop an understanding of the suicide and mental health risks among farmers. They have had conversations with the RCGP and NHS England as well as an opportunity to launch the project in the House of Lords, all groups have been supportive and hopefully this leads to national impact. The farmers wanted a similar farmer facing resource to help farmers understand their risks and where they can seek help. The project has also developed a farmer facing version. ONS 2016 suggests a two fold risk of suicide among farmers.  Data collection stops at 65 and many farmers are over this age, so the data likely underestimates the risk. RABI report 2023 shows 36% of UK farmers are depressed, 47% have ongoing anxiety and only 1 in 10 reported having good mental health. Virtual reality allows you to place people inside the environment rather than just describing it, you are immersed in the sights and sounds of a farm. People remember the lesson better after a VR simulation than following a lecture. They have created a web version of the scenario which can be streamed on a computer or mobile phone which makes it accessible to those without a VR headset.  Available for free.   Find out more about the project here: http://www.ruralminds.org.uk/   Thank you for listening to the Rural Road to Health! Rural Health Compass 

Mari Lewis is Research and Development Officer at Rural Health and Care Wales. We talk about the Sustainable Communities Lampeter project.  Episode Summary: 01.00  Mari tells us about her role and rural health interest 04.00  What is the background to the Sustainable Communities project? 06.50  What is the context of Lampeter? 10.00  How was the Cardicare/Solva toolkit applied in Lampeter? 13.55  What were some of the insights from dialogue with the community? 18.10  What are some of the opportunities that exist in Lampeter? 24.35  What were the outcomes of the project? 31.55  What would a more sustainable Lampeter look like?   Key Messages: Health is experienced differently by people living in rural areas.   Community support plays a vital role in helping people maintain independence and wellbeing. The project in Lampeter is focused on building community resilience and reducing social isolation for those living in rural areas by providing weekly socialising sessions. Cardicare used the Solva Toolkit, a pilot project started in Pembrokeshire which had positive outcomes in Aberporth.  This was used again in Lampeter. Lampeter is a small market town in Caredigion, with about 2500 people, with a strong sense of identity and a vibrant community.   The community has an aging population, with many elderly residents living alone. Loneliness and isolation continues to be a significant issues, particularly for those with mobility issues and due to limited transportation options. The existing community groups can be difficult for people to engage with so the project tried to establish a single point of contact to act as a link between the services available and the residents.  Aberporth and Lampeter are two different communities so they did some initial research and resident surveys to see how the project would be accepted.  That feedback was used to adapt the toolkit to Lampeter.   Through dialogue with the community they explored the issues that residents faced and what they would like to see. Word of mouth was the best way to spread the word about the project.  It was still challenging to get the word out to more isolated community members.  Residents said they needed support with household chores, the internet, getting transport to appointments, companionship or a buddy system so that they could have a cup of tea with someone once a week. Music based events were popular. The project wanted to approach social isolation in a preventative way. There is a need to provide a consistent weekly opportunity for people to socialize without any pressure with optional activities.  There was already strong social capital in Lampeter. There was an opportunity to create a consistent and welcoming entry point to help link to existing community assets. It is important to find accessible community spaces so that everyone in the community can get to the space.  Findings from the project: The main finding was that the model needs to be flexible to work in different communities. The project and the events need to be community-led to reflect the culture and interests of that community. It is vital to build relationships when you are working on these kinds of projects, to properly engage people and listen to them to build trust.  Partnerships strengthen reach and collaboration with local groups helps to build shared ownership which is a strong principle.   Constantly take feedback on board and avoid over formalization as it can deter people from activities.  You don't always need a large investment to strengthen community resilience.     Solva Toolkit: https://www.solvacare.co.uk/toolkit/  Rural Health & Care Wales    Thank you for listening to the Rural Road to Health! Rural Health Compass 

 Matt Paneitz is the Executive Director of Long Way Home, an organization which works on sustainable education and community transformation. Episode Summary: 01.05  Matt tells us about his role and how he became interested in working with rural communities 01.48  What is Long Way Home? 03.10  What is the philosophy behind the work of the organization? 05.20  How has the use of trash as a building material impacted the health of the community? 07.00  How did they decide to make rubbish part of the school tuition fee? 07.55  What is the context of San Juan Compalapa? 09.50  What are the challenges for education in this region? 12.08  How has the availability of secondary education impacted the community? 13.50  What were the challenges when they were initially setting up the school? 16.03  How did they build relationships with the community? 17.50  Who is part of the team of Long Way Home? 19.30  How has indigenous culture been included in the work they do? 20.46  What is the school campus like? 24.40  What resources are available to support others to do something similar? 25.35  What have been some of the most meaninful successes? 27.40   What change would you like to see in rural development and sustainability? Key Messages: The work of Long Way Home started in San Juan Comalapa, a Maya Kaqchikel (indigenous) community in Guatemala. Long Way Home is a non-profit organization which is integrating sustainable rural development, education and addressing poverty.  Built the first city park and they wanted to charge an entry fee, the entrance fee became a plastic bottle filled with trash.  There was no system for trash management, there was nowhere to put it, so they decided to use trash as a building material.   At their school the tuition fee is one plastic bottle filled with trash.  One family will send 3 or 4 children to the school and they will clean up the trash in their environment.  This then helps to clean the neighbourhood.  They were experimenting with alternative material such as trash to bring down the cost of building materials.   San Juan Comalapa is in the western highland of Guatemala, the area has volcanoes, it is 60km west of Guatemala city.  The people are mostly farmers, growing maize.   They opened the first high school in the town.  There is a lack of money going into education. Not all of the children had a space in public school. Only 30% of children were enrolling in middle school as there is 87% unemployment locally. The availability of a secondary school with low tuition fees enabled more young women to go to school.  This is also improving their chances of going to university.  Members of the community are not becoming professionals with better employment opportunities.   There were many obstacles to building the school.  It was important to know the right people in the community who could help.  Building relationships and trust was important, it meant never asking others to do something they would not do themselves. The school includes a Kaqchikel class where they learn about their language and culture. The school campus uses a variety of materials, they experimented with different building methods including tyres, earth bags, cob, and bamboo. There are 22 different buildings which have integrated conventional and unconventional materials.  They used this experience to build further infrastructure with the wider community. They have shared their experiences with other organizations around the world.  They have also shared their expertise in building with alternative materials and documented the process to create a profile for the different types of buildings.     Website: https://lwhome.org/  YouTube Channel: https://www.youtube.com/@LongWayHomeOrg   Thank you for listening to the Rural Road to Health! Rural Health Compass 

Learn more about the work of Rural Health Compass and the Rural Health Equity Chat Community. Rural Helth Euquity Chat Report: https://ruralhealthcompass.com/wp-content/uploads/2026/03/rural-health-equity-chat-report-2026.pdf  Call to Action: https://forms.gle/Dahi5d8Ms6T4Nwp6A  Join the Rural Health Equity Chat community: https://forms.gle/LxS2MTmm9tTbYehC9   Rural Health Compass on the Lancet Podcast podcast   Thank you for listening to the Rural Road to Health! Rural Health Compass 

Michelle Symes is Research and Development Officer at Rural Health and Care Wales.  She speaks to us about the research she has been involved in which is working towards a Dementia Friendly Ceridigion.     Episode summary: 01.00  Michelle tells us how she became interested in rural health and her current role 02.35  What is the context within which people in Ceredigion live? 04.45  Why was dementia an important priority to address? 06.02  What were some of the challenges facing people living with dementia? 08.30  What did their study uncover? 12.12  What insights did the study show about collaborative working in communities? 14.30  What are some of the key opportunities to improve lived experience for people with dementia? 24.50  What changes would she like to see in the next 5-10 years? Key Messages: Ceredigion is the fourth largest county in Wales and one of the most sparsely populated, 21% of the population are aged over 65. Significant youth and young adult migration.  There is an imbalance in job opportunities and career development opportunities. As the population ages, dementia becomes an important priority to address. Challenges: poor transportation networks, underinvestment in rural areas, reduced access to services and support, poor broadband access, no single point of contact for relevant information for people with dementia or their carers. The study identified a number of positive outcomes such as a wide range of support and care services at a county level and within local communities.   Cader network working on broadband access improvement. Age Friendly Forum in Ceridigion: https://www.ceredigion.llyw.cymru/resident/wellbeing-and-care/support-for-adults/age-friendly-ceredigion/ Importance of a hub or one-stop shop of information before and afer diagnosis. Prioritizing involvement of people with dementia in decision making and development of services. Consideration of wayfaring when redesigning or redeveloping a local area.  Landmarks are an important way that people with dementia know where they are.   There is a need to assess best practice within Wales to see if it can be established nationally. CaBan group at Bangor university is an example of how communities can actively participate in informing research and policy decisions. Swansea Dementia Hub - an example of how useful a hub approach can be. Knowledge is Power scheme: https://www.dementiaactifgwynedd.cymru/downloads/newly-diagnosed-knowledge-is-power.pdf  Wrexham Purple Angle Scheme part of a global initiative: https://purpleangelsglobal.com/useful-links/  Enablement of a one-stop shop for information to make life easier, earlier for those people with a diagnosis and their carers. Easy access and availability of information has to be a priority.    Thank you for listening to the Rural Road to Health! Rural Health Compass     

Prof Liam Glynn is the Professor of General Practice at the School of Medicine, University of Limerick and Chair of ICGP National Rural General Practice Standing Committee.  Prof Peter Hayes is Professor of Rural General Practice at the School of Medicine, University of Limerick. In this episode they will share the story of how Ireland transformed its rural health landscape over two decades.    Episode summary: 01.10  They tell us about their interest in rural health and about their current roles 07.10  What led to the "No Doctor, no Village" campaign in the late 2000's and what impact did that campaign have?  17.40  How did the Rural, Island and Dispensing Doctors of Ireland (RIDDI), Irish College of GPs and the University of Limerick work together to advocate for rural health? 21.10  How was the Rural Wonca conference in 2022 significant and how did they keep the momentum going after the event? 25.50  How does the state of rural healthcare in 2026 compare to what was happening 20 years ago?  32.55  What were some of the enablers and some of the challenges for policy advocacy? 35.00  What advice could you share with others who are trying to improve rural healthcare in their country or region?   Key messages After the economic crash in 2008 rural healthcare in Ireland came under pressure.  The community came together through the "No Doctor, No Village" campaign.   It began as a series of public meetings and local government leaders were asked how they would address the issues facing rural healthcare.  The government at the time did not have a plan to address rural healthcare.  They put forward their own candidates for parliament at the general election, a rural doctor became a member of parliament and was able to support change from that role. The Rural WONCA conference in 2022 in Limerick led to the development of the Limerick Declaration.   The Limerick Declaration focuses on leadership, workforce, research and policy advocacy. The conference allowed many leading experts to come together and synthesize national and international issues. University of Limerick gives students the opportunity to experience rural practice during their training.  They produce the highest number of general practitioners among the Universities in Ireland.  This supports the rural workforce pipeline.  For a successful Conference that enables change you need the support of clinicians who understand the coal face, academics who have organized conferences before and the GP College to support policy change. Building relationships and partnerships throughout the process is very important. Introduced the Rural Ambassador programme at the conference and they supported the development of the Limerick Declaration. You need some small wins to keep momentum going.  Change agendas can be slow and keeping faith is important.   Rural Practics Support Framework helped to make rural practice more viable. Workforce pipeline has been supported by longitudinal placements in rural areas.   New programme has been developed to focus on developing rural general practitioners. There is also a programme for international medical graduates to develop rural practice careers. Locum Support has also been made available to rural practices allowing rural GPs to take their annual leave and continue to provide services for their patients. General practice in Ireland is entrepreneurial, this can be a challenge in uncertain times.   Providing mentorship for new general practitioners has been important for supporting new GPs. The most important voice is the voice of those most affected - the communities.   Getting the right people in the room is important, when relationships are built, then key people will attend meetings and events when they are invited.     Advice for policy advocacy and change: Involve communities and important stakeholders.   Be prepared to work hard and be patient.  Change is not linear.   Go political where you can.  Build relationships.   Learn more:  https://www.the-iceberg.org/jmic-case-studies/transforming-rural-health-a-tale-of-3-meetings/   Thank you for listening to the Rural Road to Health! Rural Health Compass 

Betty-Ann Bryce is a Senior Policy Analyst and Rural Policy Expert at the OECD.  We take a deep-dive into the rural proofing process.   Episode summary: 01.10  Betty-Ann tells us about her professional background and how she started working in the rural policy and rural proofing space 02.55  What is rural proofing? 04.26  Why is rural proofing important for health? 08.50  Who should take part in rural proofing and at what stage in the process?  12.20  Who is responsible for gathering and interpreting "rural proofing intelligence"? 21.23  Which countries are doing rural proofing well? 32.58  What are some key factors that need to be in place for rural proofing to be effective? 39.35  What work is the OECD doing to support countries in doing rural proofing?   Key Messages Everyone is doing rural proofing, it is simply checking to see if a policy will negatively impact rural areas.  It can be called different things, rural proofing or territorial policy or applying a rural lens. Rural proofing is not for rural spaces, it is for departments that don't think rural, such as health departments.  They are the one designing policies.   Rural proofing relies on a holistic and integrated whole of government approach.  This means that different departments would sit down together and think about the direct and indirect consequences of their policies before they are rolled out.  This is often not done. A government department first needs to recognize that a policy that they are developing may have inequity embedded in it, they may not realize this.  They are not thinking about how implementation would be different in rural areas.  Who needs to be at the table?  Persons with knowledge of rural data - rural proofing intelligence, stakeholders who have relevant knowledge and the rural proofer (person from the government department). Rural proofing is a process not a strategy.  It is a trial and error process which needs to be designed in collaboration.  It needs to create tools that can be used by the "rural proofer". The rural proofer is responsible for rural proofing.  Think about what the rural proofer needs to do their job. The right stakeholders need to be involved at the right time.  This could be different at national and sub-national levels. Rural proofing intelligence is qualitative and quantitative, ideally there should be at least three types of evidence.  What is going on in rural places? It is important to use existing data and interpret it in a different way, with rural in mind.  Countries don't always know that they can use their existing data for rural proofing. Rural networks and on the ground voices are key for collecting qualitative data.   It is important that the collected rural proofing intelligence is translated so that the rural proofer can easily understand the data. We need to agree on what success is in regard to rural proofing.  Rural proofing has not failed if a policymaker does not change their decision after being presented with rural intelligence.  Rural proofing fails when the evidence is not clear or it was not gathered in a timely fashion not because an unfavourable decision was taken. Rural proofing takes time as it is a process that needs to be developed through collaboration. Finland, Canada and Northern Ireland are doing well at developing the rural proofing process.  It is in a country's interest to design policies that support rural places as these places contribute to their prosperity.  Rural places are assets and key partners.  It is important to change the framing and narrative when we talk about rural places.   Important factors for rural proofing for health: rural proofing intelligence, mapping connections between health and other departments, leverage existing initiative to improve efficiency rather than asking for more money, close collaboration between health and rural departments in the country.     OECD Webinars Rural Communication – a Three-part Dialogue Rural Communications Workshop 1: Where communication breaks down (Wednesday, 4 March 2026, 15:00-16:30 CET). Click to Register.   Rural Communications Workshop 2: What is good practice? (Wednesday, 18 March 2026, 15:00-16:30 CET). Click to Register.   Rural Communications Workshop 3: Measuring communication effectiveness (Wednesday, 15 April 2026, 15:00-16:30 CET). Click to Register. Rural Proofing – a Three-part Dialogue Rural Proofing Workshop 1: What is rural proofing intelligence? (Wednesday, 11 March 2026, 15:00-16:30 CET). Click to Register.   Rural Proofing Workshop 2: Involving the right stakeholders at the right time (Wednesday, 1 April 2026, 15:00-16:30 CET). Click to Register.   Rural Proofing Workshop 3: Delivering information that can drive action (Wednesday, 29 April 2026, 15:00-16:30 CET). Click to Register. Contact Betty-Ann Bryce here.   Rural Proofing for Health Paper Principles of Rural Policy   Thank you for listening to the Rural Road to Health! Rural Health Compass   

Wecome to Season 4!   Last Seasons's stats: >1500 downloads 21 guests (62% females, 38% male) 9 countries, 3 continents 15 episodes   Top 3 episodes of Season 3: Profs Sarah and Roger Strasser - Adventures in Rural Health Education and Research Dr Iva Petricusic - Rural Health in Croatia A/Prof Malin Fors - Geographical Narcissism and Potato Ethics   Comming up in season 4: Betty-Ann Bryce from the OECD speaks about the process of rural proofing and why it is important. Prof Liam Glynn and Prof Peter Hayes speak about how policy advocacy and strategic action has shaped rural health in Ireland over the past 20 years.   Episodes will be released on the 10th, 20th and 30th of the month between March and August 2026.   Thank you for listening to the Rural Road to Health! Rural Health Compass   

Prof Sarah Strasser and Prof Roger Strasser, a trailblazing couple in the world of rural health, rural health research and rural medical education.    Episode summary: 01.15  Sarah and Roger share how they became interested in rural health and some key highlights from their careers 15.30  What did they find most rewarding about living and working in rural areas and what was challenging? 20.50  How did they balance all their different roles with their family life? 29.30  What have been the most important research projects that they have worked on? 51.30  What is NOSM and what makes it different from other medical schools? 59.45  What were the enablers for the development of NOSM? 1:05.00  What has it been like to be a woman and trailblazer in the rural health space over time? 1:11.15  What do they see as being the research focus in rural health in the next 5 to 10 years?   Key Messages:  They have lived and worked in different countries and in different rural and remote communities. They both share a passion for rural communities and rural health.  In 1991 the first National Rural Health Conference inspired a lot of activity around rural health in Australia.  Monash University developed rural training pathways and the Monash School of Rural Health.  Roger became the first Professor of Rural Health in Australia. Roger acted as the Founding Dean of the Northern Ontario School of Medicine in Canada for 17 years.  This is a multi-site rural based full medical school. Sarah started her academic journey in Canada by teaching nurses about whole person medicine.  She then became regional director of general practice training in Australia and then became the national director of rural health and covered Indigenous health. Sarah later became dean of Health Sciences at the University of Otago New Zealand. Most enjoyed: The sense of space and being part of the community. Having a very privileged role which lets you get to know the deep issues within the community.  Using that privilege in an appropriate way and making a difference for the better. Relationships with the people and the community. Community connectedness.   Challenges: Lack of child care that works for you.  Lack of resources.  Realizing how frustrating it is when things that you need on a daily basis run out or are not working, this can be a quick way to get burnout.   Balancing their careers, different professional roles, and raising a family was challenging.   Work-life balance gives the impression that work is not part of life. Roger prefers the concepts of work-style  life-style mix. Research and teaching are integral to clinical practice.  In the daily interaction with patients there are often questions that come up, occasionally there is not an answer in the literature or when asking a colleague.  This can be part of a new research question to pursue.  It is all woven together.   It has been wonderful to see how things have changed over time.  On one hand some things seem to stay the same, on the other side everything has changed.  Over the last couple of years has been going to conferences that are full of people she does not know.   Two threads of research. One was a series of studies asking people in rural and remote communities about their needs.  They have a security need, they need to feel that there is a safety net. They first need a doctor and a hospital.  Then looking at the sustainability of rural and remote services - 22 in depth case studies.  Found that the ones that were doing well had active community participation in the running of the health service.   Looked at issues of recruitment and retention of healthcare professionals.  Explored contributing to factors of success and developed a rural workforce stability framework with 5 country partners.  Active community participation again came up as a strong factor for success.   The second thead was education and training for rural practice.  Recognizing that there is a better chance of medical graduates going into rural practice with early exposure to rural contexts.  Rural upbringing, positive rural clinical experiences and postgraduate training that prepares clinicians for rural practice are the three factors that have been shown to be most important. Immersive community engaged education.   Seeking out the disconnects and trying to prove alternative ways of doing things.  Don't accept things as they are, go and investigate and find out what needs to be done.  Communication and dissemination is an important part of research, share what you find with the relevant people.  Encourage community engagement and recognize the importance of patients as teachers. Rural practitioners are naturally effective teachers.  Doctors more generally after time in practice through their interaction with patients develop a lot of skill in teaching.   Importance of having contracts - doctors and the community knew how long they would be there and gave them an opportunity to renegotiate their position.   WHO has published updated policy guidelines in 2021 for the recruitment and retention of the rural health workforce.  Their research has been adapted for this document. NOSM came into existence because the community recognized that they needed their own medical school to have a sustainable health workforce. It is the first medical school in Canada with a social accountability mandate.  This is about improving the health of the people and communities of Northern Ontario.   NOSM has a full  immersive learning experience based in local communities.  All students have a year long integrated longitudinal clerkship, living and learning in one community.  77% of NOSM graduates are in general practice, 14% are in other general specialties like pediatrics or general surgery - a very different outcome to other medical schools in Canada.  Politics is a large part of establishing a medical school.  NOSM has support from the Mayors of the 5 main municipalities, government support and community support.  Everything aligned to enable it to happen.   Say "Yes And" to opportunities, then add some of your own suggestions or boundaries. If you find that it does not work, let it go.   Be aware of the existing rural health research and undertake research which builds and contributes to that.  Future research can enable connection of rural communities across countries.  It should be undertaken in rural communities, by rural communities and for rural communities.   Use frameworks that have already been established so that the research can add value to and build on what has already been done.  The Partnership Pentagram or Partnership Pentagram Plus is an example of a possible framework which could be used in this way.       Thank you for listening to the Rural Road to Health! Rural Health Compass

Prof Bill Ventres is a family physician, medical anthropologist and (recentrly retired) Distinguished Chair of Rural Family Medicine at the University of Arkansas in the USA.   Episode Summary: 1.30  Bill tells us about his professional background and how he became interested in rural health 04.30  What made him choose to live in El Salvador? 09.30  What has he most enjoyed about living and working in rural areas?  What did he find most challenging? 13.45 What is Arkansas like, what is the context there like? 19.00  Storylines of Family Medicine - why did he decide to do this project? 29.45  What are some insights about practicing in rural and remote contexts? 33.05  What insights has he had in his work on rural workforce development? 36.20  What were the main challenges for building a rural workforce? 38.55  What are some possible solutions to rural workforce challenges? 43.30  How are rural and urban practice similar and different? 49.15  What would his top advice be to policy makers? 51.10  Top three tips for students and early career professionals thinking about a rural career   Key Messages:  He has spent his career working with people who find themselves on the margins of society.   He started his work in urban underserved settings.  After spending some time in El Salvador he returned to Arkansas and started working in rural areas. He is now a student of Latin American Philosophy while living in El Salvador.  Many people in rural and underserved areas feel left out, many people in rural and underserved areas feel on the margins of a greater society, and that the medical system does not really attend to their needs.  He most enjoyed listening to the stories his patients told and hearing about the experiences that people had.  That is one of the wonderful things about being in a small practice, one really gets to know the pulse of all the people in the community.  The biggest challenge were the not so happy stories about access.  No one wants to be number one in maternal mortality, it is a problem of rural poverty and exacerbated by a long history of exclusion and structural racism.  Arkansas is economically the third poorest state in the USA.  There is one larger city, Little Rock, famous for what happened in 1957 when the president sent troops so that 9 teenage black children could attend the local white public school and that was the beginning of desegregation. The rest of the state is rural. Walmart is based in northwest Arkansas, so that part of the state has seen a revival.  There is huge income inequality.   Storylines of Family Medicine - this is a published series of papers that shares reflections on family medicine from residents and family physicians.   For caring for a community of patients the medical model does not work well for the kind of things that we encounter in family medicine.   There is a transcendental nature to the work that we do in family medicine. The biggest cultural barrier is between medicine and real people. He was interested in hearing what motivated other people (family doctors), they told their stories of what was the one tenant of practice that motivated them.  He asked 136 doctors to share their story in the form of short essays.   Family medicine means attending to the needs of the patient whatever they may be in the context at hand.  Modern rural medicine uses up to date knowledge transmitted to rural communities, rather than the traditional model which sends rural patients to urban centres.  The presence of a physician and the presence of a hospital helps to support small rural communities. The future is in the hands of young family physicians.  Find other practitioners who are like you and work together to speak up, advocate and receive support.   We all need support, and in rural areas sometimes that is hard to come by.  We need to find people who hold similar values and share a similar vision of the importance of the work we do.  Challenges are financial, attitudinal, geographical, and unanticipated consequences of AI in medicine.     Embed yourself in a community, find a community and do that work. Be open to a different way of seeing that work than what you learned in your medical training. We should be training people to be socially accountable to their community.  Understanding the needs of rural communities form the biomedical point of view and the social community point of view.   It is important to find people and institutions that are helpful. Finding someone whose ideas can resonate with yours. Some international organizations such as WONCA or TUFT and Deep End Project.  Linking with organizations and groups like that to become a collective course. Burnout is about not having true meaning behind the work that you do.   Have students in your office so that you can pass things on.   People living in the interstitium of society are similar in rural and urban areas.     Rural health is being disappeared in the US and funding is being cut off at present - stay the course. If you don't feel comfortable advocating, find someone who is. Medical education is stuck in a model that isn't working for rural health, let people know, show the work of rural medicine to new generations of physicians.   There is a richness to the work and it can be incredible Be in it for the long haul. I am I and my circumstances.  Grow that self over time.  The work I do is worthy and my circumstances, the rural circumstances that I chose helps to engage me, and I reciprocally engage the community.  Bring that to patients.     Thank you for listening to the Rural Road to Health! Rural Health Compass  

Heather Sherriffs & Dan Martin are medical students on the ScotGEM training pathway.  They share their experience of graduate entry medical training in Scotland, their placement on the Orkney Islands and how this is shaping their thoughts about their future careers.   Episode summary: 01.15 Heather and Dan tell us a bit about their professional backgrounds and how they got interested in rural health 03.30  What have they found most rewarding about working in a rural setting?  What has been most challenging? 06.45 What is ScotGEM? 09.30  What opportunities does ScotGEM give students? 12.30  How are hospital placements organized? 14.10  How is the course preparing them for working in a rural or remote setting? 16.30  What is Orkney like, the population, geography and care needs? 20.45  What has there experience been with weather and distance? 24.45  Who is part of the wider healthcare team on Orkney? 27.25  What does a standard GP day and week look like on Orkney? 30.30 What has surprised them about Orkney and primary care? 33.50  What are the two or three key learning point that they have gained from their placement in Orkney? 35.32  How has the experience changed their plans for their future career? 40.30  What is their advice to other postgrads who might be considering going into rural medicine?   Key messages: Both Heather and Dan had completed different degrees before going into medicine, law and teaching. ScotGEM is a course to prepare students to become a general practitioner in rural and remote environments.  It is a graduate entry degree. It is different to traditional courses as your lectures and placements are integrated, you see patients from day one and you have case based learning. The applied nature of the course really supports learning. They also have a longitudinal integrated clerkship in general practice which lasts 10 months. They have had a lot more one to one time with tutors and doctors at the hospital and in general practice, there is more exposure to clinical skills early on.   There is more space to explore and try different things during your course.  While on Orkney they spend one day a week at the local hospital during their GP longitudinal placement.   Heather would be nervous to work in a rural or remote setting if she had never had a placement in that setting before.  It is hard to imagine what the job entails if you have not seen it before.  This course prepares you really well to work in a rural or remote setting. Dan says it is a certain skill set to be able to go out and stay in a rural or remote settings. Orkney is a set of islands off the northern coast of Scotland. There is a population of about 20000 people.  There is an aging population with people needing quite a lot of social care.  During COVID people returned to Orkney.   The A&E on Orkney is GP lead and when the weather disrupts travel it can be challenging to manage more difficult emergencies.   There are four permanent GP surgeries on Orkney and a small hospital in Kirkwall.  The hospital has medicine, surgery, emergency and maternity.  GPs to normal general practice but also have their specialist interests such as dermatology, mental health, palliative care or women's health.   One of the GP surgeries specialize in diving medicine and have a hyperbaric chamber.   There is a higher level of responsibility as a junior doctor, you might be the only doctor overnight running the medical and surgical department.  The doctors say that they feel well supported. Just take every opportunity that you can get. If you are interested in something, turn up and ask questions.   There is a lot that you can do to develop your clinical skills. It has helped them build their resilience.   Dan is now considering a career in general practice and public health in a rural and remote context, he has become more interested in this following his placement in Orkney.   Heather has always been interested in working somewhere remote or rural but the past year has solidified that interest and given her confidence to take a job in a rural or remote context. Applying to medicine later in life and having some life experience can be a bit of a super power going into medical training. Interpersonal skills and empathy are building blocks that you can use.   Contact Heather: [email protected] Contact Dan: [email protected]   Thank you for listening to the Rural Road to Health! Rural Health Compass

 Dr Iva Petricusic is a rural family doctor form Croatia. She is the vice chair of the young doctor committee of the Croatian Medical Chamber and a coordinating member of EUROPREV.   Episode summary: 01.15  Iva tells us about her professional background and how she became interested in rural health 03.15  What does she most enjoy about living and working in a rural area?  What is most challenging? 07.45  What are the characteristics of the place and community where she works? 13.00  How is primary care organized in Croatia?   17.15  How is family medicine training organized in Croatia? 20.45  What are some of the challenges facing rural communities in Croatia? 26.10  What has changed to improve recruitment and retention into family medicine? 33.00  What would be needed to improve recruitment and retention in Croatia and on the islands? 38.45  What are the challenges faced by doctors thinking about going into rural careers in the European context?   Key messages: She would recommend that everyone try living in a rural area to understand the context. Rural areas have a slower pace of living and as a doctor you have multiple roles in the community. As a doctor in the village you are involved with many parts of the patient's life. This can be challenging as you can feel like you are more responsible for them and their health.   She often finds herself in situations for which she was not prepared for during her medical training or residency.   There are three general practitioners and two pharmacies serving a population of about 5000 people.  They also provide care to several nursing homes. Outside of her village there are many places that have been without a doctor for years, they have not had proper medical care, sometimes doctors would be there for a few hours every day or every other day.  Young doctors are often placed in such communities and this is very demanding. Local community supported her in getting the supplies that she needed to work but was not available when she arrived.   It is difficult to find healthcare workers and attract them to the local region. Not many young doctors decide to stay. Many GPs are retiring.  There are 2173 doctors in family medicine in Croatia and the average age is 52 years, of which 858 of those are above the age of 60.  It is difficult to find replacements. Slavonia was affected by the war.  There are areas that have been abandoned and have difficulty maintaining even a nurse in their community.   Croatia has primary care divided into three levels: family medicine, primary pediatrics and primary gynaecology, and it includes dentistry.  Primary care is also divided into private and public sectors.  However private is not really private, it means that the national insurance company directly has agreements with the doctors working there.  In the public sector the national insurance provider has an agreement with the employer that doctors work with.  Everyone works for the public sector, but they are paid differently and from the same source. After finishing medical school and internship in Croatia you can work as a GP, in the emergency department or as a prehospital doctor (with the ambulance service).    It is suggested but not obligatory to have specialist training in family medicine.  Around 1000 of the current family doctors have completed specialty training.   The residency program lasts four years, 22 months are spent with a mentor in family medicine practice and 18 months in hospital rotations.   There are no rural training pathways in family medicine residency. In undergraduate training there is a requirement to spend 1 week in rural practice.   An aging population with multiple comorbidities and complex health needs is becoming more of a challenge.   Poor transport infrastructure makes it very difficult for patients to attend secondary care appointments or attend diagnostic tests.   Not all villages have an accessible pharmacy, sometimes this means having to organize the medication for a patient to be collected by a nurse, friend or family member who can travel 20km to the pharmacy. Certain tertiary care is only available in Zagreb, 300 km away.  This can prolong the time between when a need is identified and a patient receives care.  District nurses are important members of the team who can support patient care and share important information about what is happening with patients in the community. Most of the current residency programs in family medicine are funded by the European Union.  At present there are about 300 residents in training in Croatia.  This is still not enough to compensate for the colleagues that are expected to retire. More local municipalities are recruiting young doctors, such as Istra, they invested funds in this.  Local municipalities are looking at how to attract doctors, they offer places in kindergarten for children (childcare is difficult in urban areas), free accommodation, and other privileges.  Tourist areas are not attractive to doctors in Croatia due to the extra pressures during tourist season. The number of patients per doctor can grow to 5000 or 6000. Supporting specialist interests for GPs is seen as an attractive opportunity that could support rural practice in Croatia. Housing is a challenge in rural and island communities. Healthcare facilities need investment in equipment and facilities.   Croatia has created a Doctor Atlas which provides up to date information on the health workforce.  The data is updated daily.  Family medicine is something that you either like or don't like, it is different to other medical specialties.     Thank you for listening to the Rural Road to Health! Rural Health Compass

Prof. Bruce Chater is a rural generalist, Head of the Mayne Academy of Rural and Remote Medicine Clinical Unit in Queensland,  Australia, and the Chair of Rural WONCA.   Episode summary: 01.15  Prof Chater tell us about his professional background and how he became interested in rural health 05.50  What has he most enjoyed about living and working in rural area and what has been challenging? 11.20  Prof Chater tells us how he has contributed to the development of rural practice and rural medical education in Queensland 16.40  What is it like to be in rural practice for 40 years and how do you step down and hand over well? 24.45  How has he maintained the enthusiasm to keep advocating, improving his practice, and teaching students?  31.00  How has he been involved in advocating for better healthcare for rural communities? 40.25  How was Rural WONCA established? 47.15  What have the key achievements been for Rural WONCA over the past 30 years? 51.05  Why should rural clinicians become part of Rural WONCA? 58.30  What are your top 3 tips for people thinking about a rural health career? 1:01.45  Looking to the future   Key messages: Rural practice is a chance to have broad skills. I tell my students - Do you want to know more and more about less and less or do you want to spread your wings and be a generalist? When training the key part is that you go to a good place and that doctors are matched well to rural places. The best part about living rurally is the community. What you see is what you get in small communities.  The community is genuine and you get to know the people. Continuity of care, comprehensive care and the capability that you can bring to that.  You can do a lot in rural areas. Challenges: lack of local education opportunities for children, getting things across to urban bureaucrats - "geographical narcissism", clinical challenges and "clinical courage". Clinical courage - it is about having to step up and do the right thing for someone in your community and it might be about using a skill you have not used in a while.  The key element of clinical courage is having a good network of other rural doctors to support you in those situations.  Knowing that if you do not do something this person might die.  Doctors were isolated and were not a force for good, they had to organize and get together.  He was the founding convenor for rural doctors in Queensland and Australia.  This led to the formation of the National Rural Health Alliance in Australia.   Through the College of Rural and Remote Medicine worked on developing a curriculum for rural medicine. Set up a Statewide clinical network within the Health Department.   Developed a model for funding rural hospitals that could be implemented in Australia. Currently also a Professor of Rural and Remote Medicine ensuring there are students in rural areas and making sure there is research about rural areas. Has recently retired and handed over his practice and local hospital to a new doctor - this was a test of the theory and practice he has been advocating for. It is important to have an exemplar practice, rural practice should not be somewhere where you are making a massive income, but you should be well remunerated.  You should help people that need help.   In Australia there is a mix of public and private practice, he has done a mixture of both and found that this has worked well.  Those that can afford to pay for the service and those who can not pay have a good safety net.   Be a solution not a problem to the health system.   The key has been to get lots of students and young doctors into the practice.   Do all the students come back, no, but it is about getting some of them to be inspired to consider rural practice. You can not be what you can not see. The doctor that has taken over his practice came out as a student and then as a registrar and finally said can I take over the practice. Rural generalists must provide general practice, in-patient medicine, emergency medicine, public health and some other special-skill for the community.  It bans the boring. You have to protect the next generation. With the doctor that has taken over practice, he spent three years teaching the clinical side of the practice and another three years on how to interact with the health system, interact with management, and have a group of staff. It is important to not be on call all the time.   He has looked after his community and they have looked after him.   Burnout comes from complete overwork, but it also comes from not being able to express our humanity.   They close the practice for half a day every week to talk about their difficult patients, everyone finds that very satisfying.   It is important to make sure that the service is equitable across all areas.   If you can provide good services then people will stay in rural areas. It is about trying to bring to policy makers the understanding that this is an investment, if they do it well they will have happy people, healthy people, and productive people in rural areas.   You've got to be there to be heard.  It was important to build a collegiate group that could advocate, then getting the rural communities on side and getting the politicians on side.   Give the politician the problem, but also provide a solution to the bureaucrat.  Then it is about thanking them for recognizing the solution. Recognized that this was going to be a long process. They needed to build an evidence base. It does not come quickly or easily.  You need to be persistent and continue to be there.    Rural WONCA has developed policies and declarations as well as the Rural Medical Education Guidebook to support rural clinicians.   Rural WONCA was established in 1992 as a Working Party on Rural Practice.     Top tips: Give it a go. If you don't try it you will never understand it. Be prepared. You need to be prepared properly for rural practice. If you are not trained for it you will crash and burn. Find a place where you will be supported to learn.    Rural WONCA Email: [email protected]    Thank you for listening to the Rural Road to Health! Rural Health Compass

Ashley Lambert is a medical student from the University of Swansea in Wales who is currently on the Rural Health in Medical Education track (RHiME).    Episode summary: 01.05  Ashley tells us about her background how she became interested in rural health 02.33  What does she most enjoy about working in a rural area, what does she find most challenging? 08.40  What is RHiME at Swansea University? How is it different from the standard medical curriculum? 17.50  Do they have opportunities to connect with other professions?  19.00  How is she involved in wilderness medicine and does she see it as a part of rural health? 24.30  What has surprised her during her course? 27.45  What makes for a great student rural placement? 34.15  What does she hope her career will look like in the future? Key messages: The best thing about rural areas is the community and the feeling that everyone knows everyone, and the rapport that you have with patients.   As a medical student she loves being in a rural area as there are more opportunities for hands-on experiences.  However it can be difficult to see patients presenting at a much later stage of their illness. RHiME is the Rural Health in Medical Education track at Swansea University.  This track offers rural placements and more of a focus on rural health as well as the undertaking the usual curriculum of medical school.  Regular meetings and collaborations such as mountain and cave rescue, working with rural GPs and district nurses, working on social prescribing, talks about farming and opportunities for different placements in rural areas.  Wilderness and Expedition Medicine Society has similar aims as RHiME, they encourage people to embrace the outdoors and rural life and to stay in rural Wales.  They do a lot of activities, regular group hikes, bouldering, first aid courses, teach people how to tie knots, they also work with rural health doctors and mountain rescue.   Wilderness and expedition medicine includes a lot of prehospital emergency care.  They have medical teaching in the wild such as C-spine management, hypothermia management, splinting, search and rescue, and ultrasound in the field. The RHiME track has not made connections with other rural medical education programmes, but they would be interested in connecting with other students interested in rural health. The practice made her feel welcome, she was able to sit in with all of the practice staff and see the different way that they work with patients, it was useful to see what all of the different staff did as part of their role.  Allowed her to take it at the pace she wanted to and asked her what she wanted to learn.  She was given the opportunity to speak with the patient in her own room, make a diagnosis and management plan before discussing it with the GP.  The feedback was then very useful for her learning. Swansea-Gambia Link is a project that she has been working on which will support student exchanges between the Gambia and Wales.   Contact Ashley: [email protected]  Thank you for listening to the Rural Road to Health! Rural Health Compass

 Dr Jane George is a health workforce consultant and academic from New Zealand, specialising in rural workforce and the Allied Health, Scientific, and Technical professions.   Episode summary: 01.00  Jane introduces herself using a traditional way 03.10  Jane tells her about how she became interested in rural health 07.15  What does she find most enjoyable about rural areas and what she finds most challenging? 12.50  Why did she decide to focus her research on the rural health workforce and allied health professionals? 15.30  What kind of roles do allied health professionals hold? 18.15  Is there a good distribution of allied health professionals? 21.00  What challenges are facing the rural health workforce? 24.10  Do allied health professionals have access to rural based training or rural training pathways? 26.20  What has she learned through her research about attracting and retaining allied health professionals? 28.15  What factors were getting overlooked and why were they important? 31.34  Jane expands on the themes of her research 38.10  What are her top recommendations for local healthcare organizations and for national level policy? 46.15  What is she working on at the moment?   Key Messages: The things she loves about being rural are also the most challenging things.  Wide scope of practice and the can do attitude.  We are never far from the people we serve.  Endless opportunities for advocacy.  Surrounded by inequity which provides motivation to improve what we do.  Opportunities to challenge geographical narcissism.   How do we get better at recruiting and retaining the workforce? This was the question she was searching for an answer for.  She chose to focus on what matters to allied health professionals to identify what would best attract and retain them. Finding out what made rural work worthwhile. Allied health professions in rural areas can be pharmacist, physiotherapist, podiatrist, occupational therapists, medical laboratory scientist, radiology technicians, social workers and more.  It can be difficult to know what the distribution of allied health professionals is across different regions.  The government is working on monitoring this better. Service challenges and professional challenges.  The amount of travel that is required, isolation of practice, reduced episodes of care available to stay current.  Reduced access to professional development, and a constant need to be pushing back against urban narcissism.  Social work is a great example of rural based training, as they have been providing distance training for over 10 years.  Speech language therapy has recently developed a distance learning program.   She developed 20 recommendations for rural health providers, managers, recruiters and regulatory authorities.  Shaped through the narratives of the participants and the key themes of her research. Keyt themes were: 1) sense of connection and belonging, 2) safe and supportive practice, 3) creating roles the people want to go for. Negative press, how rural communities are talked about in the media, we are starting to believe what is being said about rural areas - that it is not as good, that people there are not as skilled, that these areas are not well resources… - we can overlook common sense and practical actions we can take. Important to think about how we value and trust staff, how we help them settle and develop local connections.  Do the current policies work for local communities and local staff? Are we listening to local communities and staff, what are they telling us they need? Thinking about if what we are requesting of rural health professionals is reasonable, for example, are staff safe if they are visiting places on their own, how long will they need to travel to do their role, are we making professional support and development available.  Recommendations for local health organizations:  Reality check - think about is this reasonable to ask of our professionals, are we thinking about staff safety, are we designing the work for the context of rural How are you talking about rural areas? Be mindful of urban narcissism, recognize the strengths of rural communities. Represent rural professionals as valuable and knowledgeable. How you treat people will determine if people come and stay. Involve everyone in decision making. Value the learning needs of allied health professionals and make learning resources available. Recommendations for national policy: Making policies and procedures that are fit for rural communities.  It needs to be flexible enough to fit rural contexts Involve everyone in decision making Be mindful of biases, use rural proofing tools to check that you are thinking rurally. Use health equity assessment tools. Education policy and regulatory policy is also important for training and regulation professions play a role in developing and recognizing rural professions, advanced practice and rural generalism.    Dr Jane George on LinkedIn: https://www.linkedin.com/in/janegeorgenz/  Email: [email protected]   https://www.drjanegeorge.co.nz/   Thank you for listening to the Rural Road to Health! Rural Health Compass

Dr Malin Fors is a psychotherapist, author and Associate Professor at the Arctic University in Norway.  Her reserach focuses on power dynamics between rural and urban areas.   Episode Summary: 01.00   Dr Fors tells us about her professional background and interest in rural health 03. 25  What does she most enjoy about rural settings and what does she find most challenging? 05.45  How are challenges different for people living in rural areas regarding mental health? 09.30  What is "Potato Ethics"? 12.45  How does potato ethics show itself in rural healthcare practice? 15.52  How do new clinicians adjust to rural areas and potato ethics? 19.00  Do the differences in approaches to rural practice indicate where someone might practice in the future? What is the role of medical education? 22.15  What is "Geographical Narcissism"?  24.28  What are the power dynamics that geographical narcissism describes? 32.05  How does geographical narcissism play out in the experience of rural communities? 37.05  How does the concept of having a voice play out in rural areas? 40.00  What are some key insights that she has from her research? 44.50  What is she working on at the moment?   Key Messages: Research focused on power dynamics, and became aware that power was not only in the consultation, medical records or encounter, but also in the place.  Started to discover that "rural place" was rarely described in text books and missing in the discussion on intersectionality and power.  Approaches rural health with a psychology gaze. She met her own geographical narcissism as she had an image of the rural world as different, or inferior or that urban standards were more normative.   Enjoys that rural contexts mean you always have to stretch yourself and what you do matters, it is challenging and demanding and feels it keeps her mind sharp and developing. The most challenging is the isolation, feeling alone, feeling like the person that is always teaching and mentoring people that do not stay for long.  You can feel like it is useless. It can be frustrating to not have an expert team available.  People seem to be more ill when they decide to ask for help in rural areas.  They are sicker because there is less healthcare.  If you wait, mental health can get better on its own or it can become very serious.   Colonization of indigenous peoples' lands in Norway, generational trauma following the second world war, the community is underserved when it comes to healthcare and there is a lack of specialists,  this can also contribute to how they present to health services. Potato ethics is the ethics of making yourself useful.  In Swedish being a potato means that you are not specialized but that you could be used for anything.  It can be used in a condescending way, saying that you are not the expert. She combined care ethics and the ethics of consequences to counter the narrative that we who work in rural areas are less ethical in the way we provide care, not meeting urban standards, working on things we are not specialized enough to do, or treating people that are too close to us.   Rural healthcare professionals are potatoes, they are versatile, keep track of patients, do all the tasks that are necessary.  We often have to do tasks that are not done in urban areas to prevent disasters.   Potato ethics is the core of rural healthcare as this is how it is organized.  It is a way to describe the core of rural ethics.  It is also applicable to different kinds of healthcare settings.  We are assessing consequences, we know that if we don't treat the person no one else will, so we do what we can.  We can not assume that we have sent a referral and now the patient is taken care of.  This is not always the case due to distance or availability.  We have to make sure we follow up on our patients.   Different professionals approach being in a rural area differently.  Some people may start to point out errors and try to say how things are done in the city, pointing out what you should do because they can not see that the system is not working for these populations.  While others ask "how can I help" because they get it. Geographical narcissism is the subtle devaluation of rural people, rural knowledge, rural experience and rurality.  It is a form of oppression like others being addressed within the human rights movement.  It is assumed that no knowledge could come from rural areas, can not do research, can not be in the front and that we need to conform to urban ways of doing things.   Geographical narcissism is a way to have a term organized around power themes and to put the urban-rural theme under the intersectional lens.  It allows us to use the other movements formulations to talk back i,e blaming the victim, aggression and "urbansplaining". Rural expertise is not thought of as expertise, we are always not reaching the urban standards, however we are often going beyond in a lot of situation. Rural places are seen as being "the other" in comparison to urban places.  Talked about almost now one living there, therefore we do not count.  Often this is used as a way to explain why we are not entitled to the same services.  Rural people are not important enough to get the best care. The idea that anything goes in rural areas, people that can not get a job anywhere else end up in rural areas.   Can be explicit sometimes, like when people say if you choose to live rural then you have chosen to have less opportunities or less services available to you.   In geographical narcissism there are patterns of devaluation, exploitation, sometimes violence, this is very similar to other types of oppression. When urban experts come to work in rural areas for a few weeks, they can sometimes speak to rural clinicians as if they do not know national guidelines or how to do procedures.  Not considering that we may have been involved in developing the national guidance, do research or perform procedures independently.  This can be provoking for rural clinicians and they can feel like they are being talked down to and not be seen as equal.  When you have a language to name things it becomes more obvious and it is easier for people to become aware about their assumptions.  We need to be able to speak with confidence about what we are doing.  It is important to not only be angry but to also be open to engaging with people who have a capacity to change.  We need to use different strategies to bring awareness and change.  Geographical narcissism is also a political question, it is part of discussion about where hospitals should be placed, how many resources communities should be assigned, where schools are positioned and many other things.   Urban standards do not always fit in rural areas, ideas about how healthcare should be organized based on urban contexts will not be effective in rural areas as the context is very different.  We get told that the rural context is wrong instead of being asked what might work in our context.   Rural people are told like all subordinate groups that they are "aggressive" or "will not cooperate" or "silent" and that this is why they are not being heard or listened to. Rural communities represent "counter power" as they have small and subtle ways with which they handle or respond to geographical narcissism.   It has been surprising how many parallels you can see between rural-urban dynamics and other human rights issues.   Website: https://malinfors.no/en/psychologist-specialist-malin-fors/    Thank you for listening to the Rural Road to Health! Rural Health Compass

Satu Pirskanen is a nurse and  Project Manager at the Savonia University of Applied Sciences in Finland.  Episode summary: 01.05 Satu tells us about her professional background and how she became interested in rural health 03.05  What does she find most enjoyable about living and working in a rural area and what does she find most challenging? 04.12  How is primary care and community care organized in Finland? 08.00  What are the main challenges facing rural communities regarding their health and wellbeing? 12.15  What is the Attraction in Elderly Care Project? 15.30  Which factors were attraction and retention?  16.30 What kind of elderly care is needed in rural communities?  18.35  What other services are used in Finland to support rural populations? 22.08  How has the tool helped with recruitment and retention?  23.41  Are there any interesting projects at Savonia University and are they looking for collaborators?   Key messages:  Most areas in Finland are rural areas, there are only 9 cities with over 100 000 inhabitants, over 3 million people live in rural areas.   Well Being Counties took effect last year in Finland, they organize health and social care services and the financing comes from the state.  Municipal health centres provide primary care and they are responsible for GP services, nursing services and maternal and child health services.  They also take care of screening and preventative services.   One of the core principles of Well-being Counties is that social services are integrated with primary care services.   The challenges for rural healthcare:  distance to services, shortage of healthcare professionals, longer waiting times and reduced access to care, telehealth access is limited due to connectivity issues or lack of digital skills, aging population with greater needs, mental health issues and social isolation, and economic constraints. Attraction in Elderly Care Project aimed to identify the attraction and retention factors for elderly care staff and develop a tool to help organizations evaluate their attraction and retention factors. Created an Attraction Model which consist of 9 factors: 1) Appreciation, ")Human resources, 3) Flexible working life solutions, 4) Inclusive and supportive staff management, 5) Orientation and student guidance, 6) Functioning and prosperous work community, 7) External communication, 8) Strong professional expertise and work development, and 9) Resource oriented approach to work for the elderly. Limited prescribing for nurses helps with access to certain medications for chronic conditions such as angina and asthma.   Transportation services are available for those that have reduced mobility to help them attend medical appointments.  Data from the tool shows that many of the factors still need developing at elderly care organizations. PATHS project - for self-management or co-management for elderly care, to support transition to community led care. 13 elderly care teams are progressing towards community management. They are planning to publish a guide about this process.  Savonia University: https://www.savonia.fi/en/homepage/ Contact Satu: [email protected]    Thank you for listening to the Rural Road to Health! Rural Health Compass 

In this episode with hear from the team of the Virtual Health Hub in Saskatchewan, Canada: Dr Ivar Mendez, Dr John Michael Stevens, Dr Victoria Sparrow-Downes and Joey Deason. Episode summary: 01.25  Our guest introduce themselves and tell us about their professional background and their interest in rural health   05.26  They share what they most enjoy about living and working in a rural area, and what they find most challenging. 10.15  What is Saskatchewan like? 13.08  What is the Virtual Health Hub? 15.12  How does th Indigenous perspective and culture impact the work of the VHH? 20.17  What does the VHH do? 23.11  How are new technologies used to provide care and support local healthcare teams? 29.15   Are there challenges with connectivity or maintenance of the equipment? 21.10  What other benefits does remote virtual care provide? 37.10  What kind of training is provided to clinicians engaging with the VHH? 40.43  What has the community response been to this new way of working? 49.08  What are some of the lessons that they have learned from working on the VHH? 55.35  What are the first steps to move towards developing virtual care?   Key messages: Saskatchewan is the size of France with 30% of the population being rural and remote. There are many opportunities to leverage technology to improve care for rural and remote populations. Some of the challenges are: lack of resources, being away from family can be difficult, access to patients or patients accessing care, harsh climate, logistical challenges. Most enjoyable part of working in rural and remote areas is being part of a tight knit community and healthcare team.   The climate is harsh, especially in the winter with temperatures up to -60C.  Many of the communities are not accessible by road and can only be accessed by plane.  Due to isolation there are other challenges such as access to food, some communities may only have one small general store with limited access to fresh produce.  Some of the communities are 900 km away from tertiary care centres, it can be a three hour flight to reach them.  This can be a barrier to healthcare provision. The Virtual Health Hub is an Indigenous led project as most of the communities it serves are Indigenous.  It is a purpose built building which will have access to state of the art technology to allow clinicians to assess patients in real time and help them make a decision on the triage and treatment of patients.  It is a project supported by the governments.  It aims to serve about 90 communities.  The Indigenous perspective is crucial in the development of the work of the Virtual Health Hub.    Indigenous culture plays a role in how clinicians approach care and there is great value in having people who are familiar with the different cultures providing care through the virtual system.   Projects of the VHH are primarily informed by each community's needs. They are looking to harness the strengths of local community members and seeing how they can be involved in providing care. Developed an applied certificate course which is designed to train healthcare workers from the community on how to work with new virtual care technologies.  This enables them to work better with clinicians that are providing virtual care.   VHH has been working with remote communities and a number of issues are clear from this work: Accessibility to timely care. Local healthcare workers can feel like they have to practice beyond their scope of practice Challenges to recruitment and retention Advanced technologies allow clinicians to support the local team and the triage of patients when it is needed.  The virtual system has been able to save lives.   They have very high quality video and audio connection to other clinicians which is useful for critical cases where specialist input may be required. Clinical services are provided from a distance, a remote clinic can be performed entirely via video link where patients can connect with a clinician. VHH is piloting some new technologies to see if they work in rural and clinical settings.   Telerobotical ultrasonography is a project that makes ultrasound available to rural and remote communities. The ultrasonographer is in a central location, on the other side there is a robotic arm with an ultrasound probe allowing them to perform scans remotely.  This has been crucial for prenatal ultrasounds. They have developed a partnership with the local telecommunications provider to ensure that they have the required connectivity and bandwidth for their service.   Most of the systems being used can be maintained remotely, are reliable and can function well for long periods of time. There is a bolstering effect for recruitment and retention in these communities, the availability of remote support helps to build confidence and reassurance knowing that acute cases can be managed with a shared responsibility model. There is a large gap between telephone support and having the possibility of having an specialist see what is happening and the situation in the room and have your hands free to take action. One of the challenges of virtual care is the inability to perform a physical exam.  This has been addressed by developing a virtual health hub assistant training course. These assistants would be based in the community and be able to perform some guided physical examinations.  Virtual care done in the right way  has the ability to increase accessibility, continuity and quality of care. They encourage a team based approach to virtual care with sharing of expertise and responsibility which builds trust and capacity. They have been working to understand patient pathways and how this can be integrated into the workflow of different clinicians.   Part of their role is to make a system that is easy to use for the patients and communities as well as the clinicians and care providers.  They have a technical team that provides training to support them in working with the VHH.   Virtual care is about building trust and relationships.  When communities receive access to healthcare they embrace the technology.   They are looking to see how to incorporate translator services as different communities use different languages.  Another challenge is enabling the use of virtual care for people with hearing impairment or other disabilities.   Lessons learned: The importance of building solutions with the community. You have to be flexible and malleable in your vision - be willing to change what your project is or what you think you are working towards.  Focus on the needs of the communities rather than fitting your ideas into the communities. Remain open minded to all possibilities.  Some technologies may have been piloted in very different circumstances than they might be being used in a rural or remote setting.  Trust and relationships with the community really drive successful projects. Virtual care is a new frontier and there is an underdevelopment of protocols or guidance.  This development needs to be done. Advice for First steps: Understand the community and their needs. Do not underestimate the challenge of bringing virtual care into the workflow of clinicians. Be prepared for a huge project. Research is important, backing up your work with scientific evidence is important when you are trying to take new technologies and mainstream them.  Collect evidence, identify what is and is not valid.   Virtual Health Hub: https://virtualhealthhub.ca/  Contact VHH: [email protected]     Thank you for listening to the Rural Road to Health! Rural Health Compass 

Prof Janessa Graves is the Director of the WWAMI Rural Health Research Centre at the University of Washington.  Episode summary: 01.00  Janessa tells us about her professional background and how she became interested in rural health. 03.44  What do you enjoy most about living and working in a rural area and what do you find most challenging? 07.45  What is her rural community like, what are some of the characteristics of this area? 11.25  What are the challenges for healthcare in rural Washington?  14.19  How is rural health research organized and funded in the USA? 19.35  What is the WWAMI Rural Health Research Centre?  22.53  Janessa tells us more about a few of the research areas that WWAMI is working on. 29.03  What are some insights from your research that could apply to different rural communities?  32.20  How is the research feeding into policy making? 35.25  How is the diversity of rural places reflected in the research and policy? 39.57  Are there programmes that are gathering data on other rural issues such as information technology and transport?   43.30  Are you working on projects that you are looking for collaborators on?    Key messages:  There are fewer degrees of separation between people and places where you live if you're in a rural community, it generates meaningful connections and relationships between people. The most challenging part is limited access to services, technology and experiences.   Most of the urban centres, and most of the population in Washington lives west of the Cascades and then east of the Cascade Mountains there are expansive plains. 17 % of the population lives on 70% of the land mass.   There are limited economic opportunities in rural areas and there is limited healthcare access.  There are long distances to get to services, and there are also provider shortages. Weather impacts access to services, particularly with long distances and snow in the winter.  Research is funded by federal agencies, National Institute for Health and Agency for Healthcare Research and Quality.  The Federal Office of Rural Health Policy funds rural health research in the US, it was founded in the late 1980s.  It focuses on issues impacting healthcare in rural America.   The Rural Health Research Centre Program was established in 1988 to do rigorous objective health services research that is of interest to the national sphere and to help inform policy makers and the public with evidence to support rural healthcare.  There are a number of Rural Health Research Centres around the US, they focus on different issues and cultivate researchers that are specialized in rural health research.  The WWAMI Rural Health Research Centre, represents Washington, Wyoming, Alaska, Montana and Idaho, the states in the North West US.  The research that it does is national in perspective.  The areas of focus are rural health workforce, training of primary care providers in rural communities, substance use, behavioural health and mental health services in rural communities.   Communities can come up with creative solutions to some of the challenges that they face.  They need to be supported in accessing resources and capacity that may not be available locally.  Rural Health Research Gateway makes all of the findings of Rural Health Research Centres available to all.  This can be found at https://www.ruralhealthresearch.org/  Public health and research often does not integrate the geographic component, which is so important,  so doing the descriptive work on access to services or prevalence of mental health illness in, in rural versus urban communities or looking at substance use in adolescents in rural, across rural areas is still needed.  All the work done at the Rural Health Research Centres is relevant to policy and policy makers.  It can have a direct impact on policy and rural communities. It is important to have good representatives and empowered voices advocating for rural communities.  National Institute of Occupational Safety and Health has a program on total worker health, which is not just about industrial hygiene or preventing injury at the workplace or workplace disease and illness, but also looking at shift work and access to healthy foods and this idea that it's not just a worker but that it's their total health and wellness that's important. Contact Prof Janessa Graves: [email protected]  WWAMI Rural Health Reserch Centre: https://familymedicine.uw.edu/rhrc/    Thank you for listening to the Rural Road to Health! Rural Health Compass 

Dr Bethan Setphens, a GP and Director of Community Learning at Cardiff university, and Dr Katie Webb, a psychologist, and a Professor of Medical Sducation at the University of Cardiff, tell us about Longitudinal Integrated Clerckships in Wales and the upcoming CLIC conference. Episode summary:  01.30  Katie and Bethan tell us about their professional background and how they became involved with medical education. 04.26  What is a Longitudinal Integrated Clerkship? 08.22  How were LIC introduced in Wales? 11.29  What were the challenges of establishing this new approach to medical education? 15.43  What are some important features of LIC and how do they enhance medical education for students? 21.15  How are communities involved in LIC? What role do they play in the student's education? 23.55  What is social accountability and what role does it have in LIC? 26.53  What impact have LICs had on student's future career choices? 34.15  Are there benefits for the GP practices that engage with LICs? 49.45  What is the Consortium for Longitudinal Integrated Clerkships? What is CLIC 2025? 56.11  What are the topics and themes for the CLIC 2025 conference? 01.05.00  What are their hopes for outcomes from CLIC 2025? How do they see LICs developing in Wales? Key messages: Longitudinal Integrated Clerkships (LIC): Consists of comprehensive care of patients over time while based in one community. Students that are involved have continuing learning relationships with patients, clinicians, and they meet most of their academic clinical competencies across multiple disciplines simultaneously through these experiences.  A number of universities in the UK have started offering longitudinal Integrated clerkships. In Wales the government supported the establishment of LIC, it first started in Aberystwyth and Bangor.  Cardiff University has been running the program since 2018.  Their students are mostly based in primary care.  They develop longitudinal relationships with supervisors, the community and patients. They started as a way to try to tackle challenges with recruitment and retention of GPs in rural areas.  Getting initial buy-in from staff and students can be a challenge.  However, the learning outcomes for students have been found to be the same as for those on the standard curriculum.   Features of the LIC:  students spend a whole year in one practice and in one community, social learning, having access to a team of professionals not just one mentor, continuous learning which improves the learning cycle, builds confidence and students become more independent and they develop a deeper understanding of the social and health system context.  Students develop a sense of belonging during their time in the community.  This can lead to a feeling of responsibility for the community.  Many of them choose to help during COVID with patient care and vaccination programs.   Students live and work in the area for the year and join different community activities.  They work on a student selected project, this project often looks at providing a new service or evaluating an existing service.   Social accountability in LIC means that the student thinks about how to co-produce things with the community, gets them thinking about what the community needs and how to meet those needs through working with the community.   There have been around 30 graduates to date from their program.  Around half of those have opted during their time to stay in Wales.  They have expressed interest in staying in the same area or working in another rural area, others have changed their career preference towards general practice.  Indications at this early stage are positive. Information about CLIC 2025: https://www.cardiff.ac.uk/community/events/view/2871539-consortium-of-longitudinal-integrated-clerkships-clic-conference-2025   Thank you for listening to the Rural Road to Health! Rural Health Compass   

Professor Karen Flegg is a rural general practitioner from Australia and the current president of WONCA, the World Organization of Family Doctors.   Episode summary: 01.04  Karen tells us about her professional background and her journey into rural health. 04.20  What has she most enjoyed about living and working in a rural area and what does she find most challenging? 07.50  What has her rural leadership journey been like? 14.30  How did she go from a rural doctor in Australia to the president of WONCA? 19.15  What are some of the challenges that she has faced during this journey? 24.45  Do some of the challenges prevent rural doctors from taking up leadership roles? 26.19  What does taking up a leadership position bring to your rural practice or rural area?  28.50  Is it important for younger colleagues to develop leadership skills? 34.15  How can rural clinicians advocate for their communities and what are some lessons that she can share?  37.10  What would she like to see for the future of family medicine and rural practice?   Key Messages:  The experience of having great supervisors and mentorship in a rural environment. Colleagues stick together, provide advice and do some communal thinking on difficult problem Most enjoys the community, knowing neighbors, and the community spirit. Challenges can be the social situation, the difficulty of finding friends rather than just people that are friendly.  As the new doctor was invited to join the board of the community information centre, this was her first experience as a chair of a board.   Had an opportunity to join the board of the Australian College of General Practitioners, the reality was not what she expected.  Realized quickly that she needed a mentor. She did not actively seek leadership roles, sometimes you just say yes.   Applied to be the WONCA editor and held this role for 10 years.  Through this role she got to know many people from all over the world.  During that time also stood for WONCA executive.   Being a rural doctor has helped as it was important to have a broad understanding of what family doctors do all around the world.  Living in a place that had easy access to an airport and good internet access was an important consideration for an international leadership role.  A challenge can be understanding governance to effectively chair a board. She actively sought to learn about governance and business skills.  Concerned about planetary health, however, as WONCA president has to travel as part of her role. Balancing leadership with clinical roles can be difficult particularly with recurrent trips overseas. She has found a part time role that is flexible and this is not always possible for everyone.  She had a break from some of her roles due to other commitments, the location where she was living and other circumstances at the time.  There is an element of excitement in the local community when you hold a regional, national or international leadership role.  The community is interested in what the local doctor is doing.  Young rural clinicians should say yes to opportunities.  Getting involved in different WONCA working parties and special interest groups is one way to do this. If you can go to a conference, present something.   In 2025 there are WONCA regional conferences in April for the South Asia region and Asia Pacific region, and the World conference in Lisbon in Portugal in September.   There are Young Doctor Movements in each world region that colleagues can get involved in. The networking is the best thing about conferences. Networking is part of leadership, the opportunity to meet people and have a chat with someone from a completely different part of the world and learn from each other.   If you are going to advocate for your community it is important to get a team around you and networking in the community to understand different views within the community.   Someone might be better fitted to lead advocacy efforts and it might be that the family doctor works in the background. Leading from behind - mentoring other people, delegating to others who might be better suited to the task, networking and having a team of people who are involved.  It is lonely being a lone ranger.   She would like WONCA to be the go-to organization to advise on primary care and family medicine.  Rural workforce issues are most concerning.  Rural communities and rural doctors are aging.  She is keen to give medical students exposure to rural practice and rural training.   WONCA has a special interest group for policy advocacy.  They are thinking about leadership and advocacy. There is also a young doctors leadership program that has been launched recently.  There are many opportunities to step up and get involved in leadership.    WONCA conferences: https://www.globalfamilydoctor.com/Conferences.aspx  WONCA working parties and special interest groups: https://www.globalfamilydoctor.com/groups.aspx  Young Doctor Movements: https://www.globalfamilydoctor.com/groups/YoungDoctorsMovements.aspx    Thank you for listening to the Rural Road to Health! Rural Health Compass 

Dr Chris Rice is a qualified nurse and paramedic, and Associate Head of Postgraduate Medicine at Edge Hill University in Lankashire.  His doctoral thesis explored the recruitment and retention of nurses staff across northern Scotland's non doctor islands. Episode Summary: 01.30  Chris tells us about his professional background and how he became interested in rural practice. 03.25  What does he most enjoy about working in a rural area and what does he find most challenging? 04.57  What are the health services and the population like in Shetland? 10.45  Why did he choose to research recruitment and retention of nurses on the Scottish Isles?  12.05  What are the skills and competencies that nurses need to work on the Scottish Isles? 17.19  How is the infrastructure on the islands? 19.00  What are the opportunities for training or professional development on the Scottish Isles? 21.10  What were the insights that he had from his research on recruitment and retention? 24.33  What factors play a role in retention? 27.37  What are younger nurses not choosing to come to the isles? 29.45  What are his recommendations for improving recruitment and retention of nurses? 34.30  What is he working on currently?   Key Messages: The biggest reward is holistic patient care, getting to know the patients, becoming part of the community, and a sense of belonging which is unique to rural practice. Challenges - being on-call 24h a day, being the only medically trained person on the island.  NHS Shetland covers a population of about 22 000, there are about 5 no-doctor islands, they are remote and accessible by boat, plane or helicopter.  Population on these islands varies from 15 to 450 members of the community.   Depending on the weather it can be challenging to transport patients off an island, they collaborate closely with other emergency services and they have equipment on the island to help them manage critical patients when needed.   The healthcare professionals on the ground on the islands are usually nurses who are there 24h a day, living on the islands, provided with accommodation and transport.  Patients are linked to a local GP who may or may not be based on the island.   What drove him to move to the Scottish isles?  He wanted new challenges for his practice, delivering continuity of care and being part of the community.  He wanted to understand what drove others to make a similar decision. A variety of skills are needed, primary care, emergency care and chronic disease management. There is always somebody at the end of the phone, there is always a GP on-call, an advanced practitioner or emergency services.  Ultimately you still need to make the clinical decision for the patient in front of you. Provided with trauma and emergency training and the Sandpiper trust provides training and a bag with emergency equipment.   The majority of nurses came to the isles for a change of career, they were looking for something different.  Many of them came to the isles ahead of retirement.  The majority were over 50 yrs of age. The nurses were from A&E, GP or acute medicine backgrounds. Work-life balance was a key factor for retention of nurses.   The community finds work for partners of those coming to work on the isles. Younger professionals are more focused on building a career and this can be easier in more urban areas. The younger generations tend to go off island to get the experience and build careers and then they return later in life.   It is important to have an open and honest dialogue about what the job is and what to expect. There are new training pathways being developed for rural and remote practice.     Contact: [email protected]     Thank you for listening to the Rural Road to Health! Rural Health Compass  

Susanne Tegan is the CEO of the National Rural Health Alliance in Australia and an advocate for rural communities.  Episode summary: 01.15  Susanne tells us about her professional background and how she developed her interest in rural health. 06.00  What does she find most enjoyable and most challenging about living in a rural area? 12.50  What is the National Rural Health Alliance? 17.55  How did the membership organizations come together to form NRHA?  How did that aid advocacy efforts? 21.20  What are some of the main challenges facing rural Australians when it comes to their health and wellbeing? 28.05  How is the NRHA trying to address some of these challenges and what is their role? 35.50  How does the NRHA work with others outside of the healthcare sector?  41.15  What will the NRHA be focusing on over the next few years? Key Messages: Addressing population health needs, and dealing with solving problems when you don't have all the ingredients you need. Lucky to have amazing space outside of the city, gives you peace of mind and time to reflect and think. Sun up and sun down, smells, bird sounds, it really centres you.  People pull together after disasters, sterling examples of innovation and resilience. The hypocrisy of rural people being seen as "hicks" as they may not look like they are well educated.   Two thirds of Australia's export income comes from rural, remote and regional Australia and so does 90% of the food that Australians eat, and they bring in 50% of the tourism income.  Rural people make up 30% of the population (7 million people). Everything is more expensive, the "tyranny of distance" places stress on individuals, businesses and communities. Rural communities are more sensitive to economic downturns.  In Australia people are dying 12-16 years earlier in rural and remote areas than in the cities. The National Rural Health Alliance (NRHA) is a non-profit, funded by membership fees and the federal government.  An agency with 53 members, entities that work along the patient journey or in health workforce education pathways.  Supports researchers in rural Australia.  Geographical narcissism where we have a belief that if something is developed or driven by the city it must be good, but if it is driven by people on the ground that its second rate.  It isn't, but it's different and it may need different funding models. NRHA looks at increasing the understanding of issues facing rural health, workforce shortages, socioeconomic needs of rural communities, they advocate for collaboration based on values and need driven with the community being part of the development of initiatives.   NRHA reminds the government that taxpayer money which is to be used to meet the needs of the citizens. NRHA is now 35 years old, in 1991 the first National Rural Health Conference was held in rural Queensland.   NRHA has been promoting working together of national and federal governments and advocating for a national rural health strategy.   Rural Australians are sicker and are dying up to 16 years earlier.   More than 50% of rural doctors are international medical graduates.  Revolving door of clinicians, doctors, nurses and allied health professionals, many communities are feeling let down and not supported.  From research of government funded programs, rural Australians are getting AUS$6.55 billion per annum less spent on them, this is about $850 less per person.   Rural and Indigenous students are much more likely to return to their rural and remote communities to work after graduation.   Big issues: workforce, population health needs, underfunding and inflexible funding, multidisciplinary care, possibilities, governments working together and seeing the importance of governments working with communities. NRHA is on a number of ministerial committees who are involved in setting policies and providing feedback from the grass roots.   NRHA participates in state and federal senate inquiries and they provide submissions for questions relating to rural health and rural communities supporting their members to provide evidence and asks aligned with shared goals.  NRHA works closely with other industries based in rural communities as they are important for the health and wellbeing of those communities. The value chain is not just health.  NRHA has asked for AUS$1 billion over 4 years and 50% of that to be block or blended funding for those communities and regions where the market has failed to support infrastructure and the other 50% to go towards health services.   We need to do something differently as we now have the data and know that inequalities exist. What will NRHA be focusing on over the next few years? 1) Australian National Rural Health Strategy this includes the AUS$1billion fund, 2) building a community of practice through developing a Rural Health Hub, 3) closing the gap regarding Aboriginal health access, 4) working with communities for disaster planning and resilience, 5) supporting clinician wellbeing, 6) advocating for more funding for rural research, and 7) international community of practice.    NRHA website: https://www.ruralhealth.org.au/  Email Susanne Tegen: [email protected]    Thank you for listening to the Rural Road to Health! Rural Health Compass 

Welcome to the 3rd season of the Rural Road to Health Podcast! Episodes will be released on the 10th, 20th and 30th of each month between January and August 2025. Thank you for listening to the Rural Road to Health! Rural Health Compass 

Its the end of another season, I hope that you have learned as much as I have from our guests! 2.5x more downloads 28 episodes 31 guests (18 female, 13 male) 23 countries    Top 5 episodes this season: Prof Nuno Sousa talking about P5 Digital Medical Centre in Portugal Dr Rebecca Orr talking about Farmers Health in Northern Ireland Dr Jaka Strel talking about Rural Practice in Slovenia Melanie Hartman talking about Rural Nursing on the Haligen in Germany Cristobal Escalona talking about Rural Innovation and Sustainable Development in Chile   Feedback form for the Rural Road to Health Podcast:  https://forms.gle/drbKHiT9YSjwj2b76 As part of my masters reserach I am exploring expreinces of rural clinician in engaging with the policy process. If you are interested in exploring rural stakeholder and community engagement in the policy process or have already been doing work in this area, I would love to speak with you, please reach out at: [email protected] [email protected]    Thank you for listening to the Rural Road to Health! More episodes in Febuary 2025.  

Tony Joy is the founder of Durian, an NGO focused on empowering rural women to become self-sufficient by providing them with the knowledge and skills needed to transform their local waste into a means of livelihood.   Episode summary: 00.55 What inspired Tony to work on rural issues and with rural women? 13.45  What is the perception of rural communities in Nigeria? 20.10  What is life like for a woman living in a rural area in Nigeria? 27.15 What is Durian?  What does it do? 35.40  Why is it important to engage rural women? 39.00  How has the mindset transformation impacted women that Durian works with? 44.20  What does she hope for the future of Durian? 49.15  What projects is Durian working on?   Key messages: Young people are often told they are not doing anything, that they are good for nothing and that they are not contributing to the economy in the African context.  These are also things that people in villages are told.   In 2016 started a project to show the community how to transform plastic waste into new products.   Realized that they needed to use local waste and local resources to solve problems.  There is no community that does not have some kind of resource.  The community needs to understand how to use those local resources as a tool and own it to find solutions and a means of livelihood.  Rural communities are seen as places to exploit.  They are the poor, marginalized and forgotten places.  The new drive towards exploitation as they are seen as green areas that real estate agencies buy to turn into new property developments, or large businesses buy the land and use the natural resources for business purposes.   Rural communities are losing all their green areas, it has been filled up with houses and shops.  Farmers have lost land in their own communities and they are having to lease land in other areas so that they can continue with farming. Women are already disadvantaged, rural women are even more disadvantaged.  There is a culture that says that a man is in charge of a woman, they determine their life, where they can go and what they can do.  Young women are encouraged to get married early.  These women have dreams but do not have the opportunities to achieve them.   Women do not have rights to own land.  It is seen as culturally wrong.  Questions start to be asked about where she got the money, if she is trying to compete with men, or who she thinks she is.   Nigeria is a large country with diverse cultures.  In some areas the women are the owners of the land or own small businesses.   Choose the name Durian as it is a fruit that stinks but tastes good.  This reflects Tony's story and the story of the women that she works with.  Rural communities are poor, marginalized and underdeveloped, but they are the future.  Waste is the future and supports sustainable communities.  Encourages to see beyond the stink, the obvious and the ideologies, look beyond that and see the opportunities that exist.   Durian is working on creating sustainable systems and structures in places where they are told that they can not do it.  Showing communities that they have a resource that can be used to develop their livelihood.  Supporting women to become the drivers of change in their community.  Creating new identities for the women and their communities.   Women are incredible story tellers, they can take knowledge from one generation to the next easily.  When they work with a woman they transform the future of their whole lineage.   Many communities already have an idea of what they want to do.  Durian supports them in developing the skills and knowledge that they need to achieve this. If you want to create sustainable change in a community and have it a system then you need to engage local women.  Women have always been silenced, and creating a space for them means a lot of transformation in communities.   If you want to work in rural development, you need to be there and you need to invest time to see real change and transformation.  A lot of work to be done with mindset, ownership, resource management, green environment and more. Rural Rights Network - they learn about their rights and they stand up for their rights now.  Durian hopes to become the leading organization in Africa for sustainable, systemic and human centered rural development approaches.  An organization that is redefining rural and highlighting the beauty and strengths of these communities.  They want to close the gap between research and implementation.  Rural people need to speak for themselves.   Durina has started a Green Fellowship which trains rural enthusiasts around Africa (Kenya, Malawi, Uganda, Zambia, Nigeria).  They are looking for partnerships to support fellows in implementing projects.   Rural Rights Network looking for partnership with human rights organizations to support legal processes when this is needed.  Durian is looking for research partners to improve the products and processes that are being developed with waste and repurposing in rural communities.     Learn more about Durian here: https://www.durian.org.ng/  Contact Tony: [email protected]    Thank you for listening to the Rural Road to Health! Rural Health Compass 

Sadie Lavelle Cafferkey is a registered nurse working on in the Republic of Ireland. She is currently doing a PhD with Trinity College Dublin.  Her project is looking at developing integrated nurse led addiction services for rural communities.   Episode summary: 01.10  Sadi tells us about her professional background and how she became involved in the field of addiction. 04.00  What has your research shown about historical data on addiction in rural hospitals in Ireland? 07.35  What are some of the triggers for addiction in rural Ireland? 08.15  What services are currently available in rural areas? 10.15  What is an addiction cycle? 13.40  Why are you advocating for nurse-led models of care? 16.50  What would need to be implemented or changed to enable nurse-led models of care? 19.15  What is your advice for health professionals supporting people with addiction in rural areas? 25.50  What do we need to be aware of in regard to the experience of people with addiction in rural areas? 30.50  What are the main findings of your research so far? 30.25  What are her three recommendations for how to move forward?   Key messages:  During her masters she learned about the lack of resources in urban settings relating to addiction services, she became interested in exploring the situation for rural areas. Her PhD is focusing on providing a nurse led addiction model of care for resource poor and rural settings and it is a mixed method study. A 10 year retrospective analysis showed that alcohol is a significant issue but there are also pockets of certain substance abuse in different hospitals.   Nurse led model of care will not be a one size fits all, it will need to take into account what the patients need, what the hospital needs and what the nurses need to make this approach work.  Local rural services are inundated, hospitals are seeing a rise in people suffering from alcohol and substance abuse.  However there are no addiction services to refer them to. A person will come into the hospital while under the influence of a substance, they have their medical condition treated and they might be offered detox.  Following this they are discharged without any support offered in the community.  The person then slips back into addiction.   Why nurse-led care? Nurses make up nearly half of all healthcare professionals, this makes them accessible.  They provide 24 hour, 7 day a week care.  Nurses are good with health education. Nurses are adaptable.  Nurse led care is very safe and very effective, it saves governments a lot of money.  Patients trust their nurses.  Nurses advocate for their patients.   What would need to change to enable this approach?  The way that things are recorded and reported.  Nurses need to be able to specialise in addiction care and they need to be able to prescribe.  We need to change minds to allow for changes to happen. Rural communities benefit from nurse-led models of care. Taskforce for drug and alcohol, they can be a resource for supporting clinicians.   The "Healthy Options Clinic" was something that the nurses started to reduce the stigma of attending the surgery for substance use issues. Access to services, access to the internet, access to public transport, all of these factors can be barriers to seeking help.  It is not just a healthcare issue, we need support from other sectors to enable good care.   The environment needs to be stigma free and safe. The nurses need training and upskilling along with support form leadership and management Nurse prescribing is important in substance use clinics. Having rapport with patients is important for providing care and finding out what they need. We need a better reporting system to gather good quality data. We need better digital services in rural areas.   How to move things forward? Digital, nurse prescribing and good quality reporting system.     Online course on addiction treatment: https://www.mooc-list.com/course/addiction-treatment-clinical-skills-healthcare-providers-coursera  https://www.mooc-list.com/course/managing-addiction-framework-successful-treatment-edx    Contact Sadie at: [email protected]    Thank you for listening to the Rural Road to Health! Rural Health Compass   

Dr Juan Barranco is a rural family medicine doctor from Spain.  He is a member of the EURIPA International Advisory Board and a member of the rural section of SemFYC an organization for family doctors in Spain Episode Summary: 00.49 Could you tell us about your background and how you became involved in rural health? 02.45 How is primary care in rural areas organized in Spain? 05.41 Who are the members of the primary care team? 08.54 What are some of the challenges faced by rural communities in Spain regarding healthcare? 11:04 Does Spain have rural training pathways for students and clinicians? 15.18 Could you tell us more about how the rural health group within semFYC? You hold a rural health conference every year, could you tell us more about the next conference that will be held in October this year? 20.33 You hold a rural health conference every year, could you tell us more about the next conference that will be held in October this year? 23.05 What do you enjoy most about being a rural family doctor? 25.56 What are your top 3 tips for people thinking about a career in rural health?   Key Messages: Primary care in Spain is organized by the public administration, there are 17 regions.  As a doctor you compete with other doctors for positions that are available and according to this you are allocated to a particular location.  Not many doctors compete to work in rural areas.  There are places in rural areas that are missing family physicians. In Andalucia there are challenges and there is a lack of health workers in rural areas.  Spanish doctors are moving to other countries in Europe and there are doctors from abroad, from South America, coming to work in rural areas of Spain.   Varied population for which he provides care which includes a lot of complexity- for local communities, local care homes, and migrants that have moved to the area.   Students and trainees are exposed to the complexity of care provided in rural areas and the types of challenges and problems that rurality brings.   Rural experiences for medical students are not very common in Spain.  There is limited education on primary care as medical education is very hospital centric.  The only exposure to rural medicine is during family medicine training as every trainee needs to spend time in a rural setting. There are no current support networks for doctors choosing to work as a rural family medicine doctor.   Adapted training for rural areas depends on individual tutors that trainees have exposure to.  There is not a standard curriculum for rural skills. The rural section in SemFYC aims to promote rural medicine, organize an annual rural forum, provide rural specific training and support for rural clinicians.    The annual rural health forums have more than 300 GPs. There is a revival happening in rural medicine in Spain as doctors are looking for places where they can practice real family medicine.  This year's forum is planned for October in Trujillo and will have a focus on mental health.  They are inviting organizations of rural women as these associations are very active in community life.   What does Juan like the most about being a rural doctor?   Being a generalist and dealing with complexity. What does he find most challenging as a rural doctor?  To stay connected with others.  There are 50 people working in the health center but most days he is working on his own with his nurse.  Top tips for people thinking about a rural health career: 1) Every doctor could develop a high quality career in a rural setting, 2) Be brave and step out of the mainstream especially if you are young and exploring options for your career, 3) take the opportunity to discover rural medicine.   Rural Health Conference in October 2024: https://jornadasrural.semfyc.es/   Thank you for listening to the Rural Road to Health! Rural Health Compass

Prof Jean Ross is a professor of nursing at Otago Polytechnic in New Zealand with many years of experience advocating for rural health and rural nursing.  She is a member of the Global Rural Nursing Exchange Network leadership team.    Episode summary: 00.45 Could you tell us about your professional background and how you became more involved with rural health? 06.06 What is the state of rural nursing in New Zealand? What role do nurses have in NZ rural health systems? 10.53 What is the Global Rural Nursing Exchange Network? 12.57 What are some of the challenges that nurses face when wanting to work in rural areas? 14.42 What does the Global Rural Nursing Exchange Network do? 17.44 How can the network support students and nurses? 19.12 Do you collaborate with any other healthcare networks? 22.08 What are your plans for the year ahead? 27.10 Are you looking for any collaborators for any upcoming projects? 28.00 Where can people learn more about GRNEN?   Key Messages: In the early 1990s there was a big movement around rural health in New Zealand led by general practitioners who were raising the issues of maintaining care in rural areas. In 1994 the first Centre for Rural Health was set up in New Zealand, Jean worked on this with Martin London.  Last year (2023) the first ever National Rural Health Strategy was established and is now part of the government mandate in New Zealand. Rural nursing has changed significantly over the last 30 years relating to legislation and regulation.  Movement for continuing education for nurses and the Health Practitioner Competence Act.  Survey on nursing on the South Island - it was not just practice nurses looking after the population, there were nurses with many different titles.  It looked at what is their practice, what they do, how they are paid, who does what, why and how, how are they supported and what is their education.  The survey found that they required a specific tailored education and a support network.  In 1996 a postgraduate certificate was established for rural primary care supported by the University of Otago.   The Global Rural Nursing Exchange Network (GRNEN) was formed so that rural nurses could share and exchange their experiences with others globally.  Due to COVID19 physical exchanges were not possible.  Education can be one of the challenges faced by nurses in rural areas, there is isolation, limited transportation, lack of access to services.  The majority of nurses are women and often take on additional responsibilities in their personal lives and in the community.  This can affect the time, space and access to continuing education.   GRNEN established and online space for rural nurses to connect, talk together, support each other and learn from each other.  On the website there is a virtual library of resources which is free to access.   GRNEN is developing a number of educational modules for rural nurses, exploring rurality and career development.   GRNEN has a focus on students, there are a number of grants available for students to exchange their understanding or rural practice with a counterpart form another country.   CHASE Model - Community Health Assessment Sustainable Education Model.  This model has three stages and 11 phases.     GRNEN: https://www.grnen.org/   CHASE Model: https://link.springer.com/book/10.1007/978-3-031-43201-9 https://thescopes.org/assets/scopes/SCOPE_HW5_060-Ross-et-al.pdf   Thank you for listening to the Rural Road to Health! Rural Health Compass

Gréanne Leeftink is an assistant professor within the department Industrial Engineering and Business Information Systems, in the CHOIR research center at the University of Twente.  Her research focus is on healthcare process optimization, using Operations Management/Operations Research techniques. Episode summary: 01.14 Greanne tells us about her professional background and how she became more involved in healthcare in rural areas. 04.55 The University of Twente and the work of the CHOIR research center. 09:14 What can mathematical models bring to primary healthcare? 13.24 How do mathematical models apply when dealing with limited resources? 15:33 The importance of taking variability into account in those mathematical models.  22.08 The Virtual Care Centre of Isala. 27.08 What has the feedback been from healthcare staff and patients? 30.41 How were the healthcare professionals involved in implementing/developing that idea? 32:00 Were there any issues with digital literacy and how do you deal with these? 34.35 How do mathematical models have been applied to the challenge of freeing up clinical time? 37:08 How widely are these being used in the Netherlands and in Europe? 39.46 Key insights from Greanne's research regarding how care is provided in rural areas. 41:49 What other research is planned at the CHOIR and the University of Twente.    Key messages: CHIOR Research Centre is one of the world's largest research centers on healthcare logistics. In industry and business all processes are optimized to the tiniest detail.  People say that this can not be applied to the healthcare setting. However the same mathematical principles apply to healthcare and can be applied to healthcare settings. CHIORs mission is to help healthcare organizations improve their quality of care and quality of labor and efficiency by redesigning their processes.   Rural health has challenges such as access to care, drug availability, supply chain reliability, emergency response, cost efficiency etc, which all have a logistic component to them.  Rural populations deserve to have the same quality of care as the urban population. They worked on a mobile care clinic which provided care in different villages. They needed to determine what the optimal location of the mobile care clinic would be to ensure that all the villages were served at least once every second week.  They used mathematical models to determine this.  Access once a week or every second week is often not enough, so they factored in having a van in an area that was more accessible in regard to distance every 48 hours.   Capacity management which entails planning and scheduling solutions which focus on efficient deployments.  Using mathematical models they have created better work schedules with more evenly distributed workloads.  This can reduce work pressure for employees and improve efficiency by 15-50%.   What can mathematical modeling bring to a primary care center? It can address the challenge of variability of workload.  If we can quantify the variation to some extent, we can plan the work schedules in a better way.   Sometimes it is important to recognize that some things in healthcare can not be fully optimized, you have to accept that sometimes certain resources and staff will not be fully utilized, however this flexibility is important for staff satisfaction.   Rural care is by its nature less efficient, and sometimes the conversations stop here and the recommendation is to pool everything in cities.  However this is not the best approach. A way to approach this is task differentiation or by taking on a different type of activity, for example having physical consultations combined with digital consultations.   They look at a process and try to grasp the notion of variability in that process, then they try to reduce that variability.  However at some point you can not reduce this variability further.  So we have to try to adjust your capacity to the variability and this can be done by having flexibility.   Allocating flexibility is unique to each situation, one way will not work for everyone.  The solution that works for the neighbors may not work for us. In the Netherlands women have the right to give birth at home.  They used a simulation model to see how many midwives would be needed to provide good quality care to rural women.  Long and variable travel times and an increase in the number of births affected availability of midwives particularly in summer months so pregnant women would be asked to go to the birthing center in the summer to reduce risks.  During the rest of the year rural women can give birth at home.   Isala Hospital Virtual Care Centre has a program for connected care.  The aim is to bring care closer to patients home using remote monitoring to reduce time spent in hospital or the need to attend clinic appointments.   Remote monitoring solutions are becoming more reliable and they provide opportunities for people to maintain independence and receive care in their homes. Modeling and data analytics in healthcare has grown in recent years.  In hospital settings this is used more often with dedicated capacity managment teams for planning and scheduling from strategic to planning level.  Now primary care is also interested in exploring this approach.     CHIOR at the University of Twente: https://www.utwente.nl/en/choir/    Thank you for listening to the Rural Road to Health! Rural Health Compass

Cristobal Escalona is the director at Balloon Lab at Ballon Latam, a social enterprise supporting rural innovation and sustainable development in rural areas of Chile. Episode summary: 01.00  Cristobal tells us about his professional background and how he started working with rural communities. 07.45  What is Balloon Latam and where did the idea originate from?   14.00  Why are the activities of Balloon Latam needed in Chile? 19.40  How does social entrepreneurship build social capital and encourage social participation? 26.30  What are some of the big challenges that they are trying to tackle and how are they approaching them? 35.30  What is the index for community resilience?  44.55  What new initiatives is Balloon Latam working on? 49.10  How is health and wellbeing being addressed in rural areas of Chile?   Key messages: Balloon Lab is the innovation and research department at Balloon Latam.  Balloon Latam works with entrepreneurs in rural communities. Nationally and at system level there are competing priorities.  Not everybody thinks about rural communities and rural problems.  It is important to create change in the communities that are at risk due to lack of investment. Founder of Balloon Latam adapted the business model canvas to rural contexts.  Working with rural entrepreneurs is just one program that the company works on. Balloon Latam is a social enterprise and B-corp, they want to show that there can be a viable and sustainable business model and sustained impact in rural areas.  They work with intangible assets such as networks and trust. As part of this work they have  developed a community resilience index to make their work more tangible.   Chile has beautiful natural landscapes, the capital Santiago is very developed, this is not the case in rural areas, unfortunately Chile has a high GINI index and there are inequalities in access to wealth, health, education and transportation. The Chilean government struggles to reach rural areas, because priorities shift, some communities are very remote or due to conflict areas.  There is a need for a sustained approach to working with rural populations.   Chile is a very diverse country with different cultures, landscapes, and temperatures.  It makes it difficult to create a policy that meets the needs of all those communities.  Balloon Latam brings together local entrepreneurs to help build capacity by teaching skills and it also gives them an opportunity to connect with other rural entrepreneurs.  This activity in itself builds social capacity in the local community.  They can then leverage these relationships and trust to build community projects and initiatives.  Social capital and community engagement is built into the way that they work.  An overarching challenge in Chile are natural disasters such as flooding.  These threats are happening more often and more severely.  Soil is important and they are looking at how they can restore soil and promote resilience with the community sustainably.  Community based solutions that Ballon facilitates are necessary but they are not enough given the severity of the issues, however they can validate that addressing these issues are important and this can create system change.   They have been exploring ways to build community intelligence on disasters and environmental threats.  It is interesting that usually the only people that participate in such exercises are qualified informats or scientists, no one has asked the community members who have lived there for a long time.  It has been interesting to see what happens when they discuss the issues together and bring their different perspectives.   They do impact evaluations of their programmes to help collect evidence.   They noticed that there are no numbers on public infrastructure that is insured, how many people are trained in first aid, emergency vehicles in the ares, no quantitative measure of potential losses, no one knows how much is being spent on resilience.  There was no way to calculate the impact of initiatives without this baseline.  There is so much information that we need and we don't have. Trying to solve the gap between territorial knowledge and the GIS information that governments use to make decisions.   They created a resilience index and are now implementing it.  They have just finished a pilot in one rural community which has a disaster unit.  This is an outlier and positive example of community resilience.   Access to water, water sanitization and lack of water keeps coming up in their work.  Chile has a desert and also lush forest areas.  Water plays a vital role.   Distance, geography and access to healthcare remains a challenge in Chile for the health and wellbeing of rural people.     Balloon Lab: https://www.balloonlab.cl/ Ballon Latam: https://balloonlatam.com/en/inicio/  YouTube: https://www.youtube.com/@BalloonLatam/featured    Thank you for listening to the Rural Road to Health! Rural Health Compass

Dr Anette Fosse is a rural GP and researcher at the Arctic University of Norway.  She is also the director of the Norwegian national center for rural medicine. Episode summary: 00.45  Anette tells us about her professional background and how she developed her interest in rural health and research 04.00  How is the healthcare system organized in rural Norway? 06.05  Who are the members of the wider primary care team? 09.30  Do the medical secretaries receive specific training? 10.45  What are the characteristics of arctic populations?  14.30  Are clinicians trained to deal with more extreme conditions and isolation? 16.00  What is the Norwegian center for rural medicine? 17.55  What kind of research has been done by the Norwegian Center for Rural Medicine? 20.45  What were the insights that came from the research on medical education for rural areas? 26.30  Have there been challenges to find mentors or clinicians to supervise students? 28.05  Are there support networks for clinicians in rural areas? 29.30  What has caused the increase in the use of locum doctors and what were the findings of the research?  34.42  What are rotational positions for doctors and how are these being used by municipalities? 40.00  What other research is planned at the Norwegian Center for Rural Medicine? 44.15  What are you top three tips for people thinking about going into a rural health career?   Key Messages: Primary care is organized by the municipalities, the general practitioners are contracted by the municipality.  In rural areas there is not a market for running your own general practices so the practice is run by the municipality which employs GPs. All GPs with a contract with the municipality have a duty to participate in out of hours services.    Every citizen in Norway is entitled to have a named GP, the average list is 1000 patients.  In rural areas the GPs have fewer patients on their list, however they perform other duties such as out of hours, monitoring care homes, and child preventative care. Average practice does not have nurses or other allied health practices, there are health secretaries which take phone calls, then can do ECGs, wound dressing, things which may be done by nurses in other countries.  Norway is starting to introduce nurses into general practice. Medical secretaries receive 2 years of training.  They are not trained to the level of nurses.   Weather can affect travel significantly for patients, some communities can be cut off and isolated.    There is no standard training for rural practitioners in Norway.  There is a good system for specialist training for family medicine, they all take an emergency medicine course and collaboration sessions with local ambulance services.   The Norwegian Center for Rural Medicine is a national center focused on improving recruitment and retention, research and education.  It has been supported by the government since 2007.  They aim to bridge health, academia and policy to work together to address challenges.   "Making it Work" - a research project looking at recruitment and retention.  Systematic review on educational intervention to ensure provision of doctors in rural areas trying to find the answer to what medical education needs to provide to help students choose rural practice.  Last year they did research on the use of locums as the use of locums is exploding in rural areas.   Project on primary healthcare teams looking at how to include nurses into general practice.   University of Tromso was one of the first medical schools to be located in a rural area due the need for doctors and other healthcare workers in the region.  It was established in the 1970s. The things that have been found to increase amount of students choosing rural practice are: Preferential admission from rural areas. Curriculum relevant to rural medicine. Decentralized or distributed medical education based in rural areas. Practice oriented learning in rural areas.  All of the medical schools in Norway have started to apply distributed medical education, sending students to smaller towns.   It is not difficult to get GPs to supervise students in their practice, what has been more difficult is to get rural GPs to teach at the University in Tromso.   All trainees have to join a mentor group with other specialist candidates and a supervisor, those groups will often be located within the same regions and they can share experiences.   When the crisis reaches the cities that means that there has been a crisis in rural areas for a long time.  The authorities often only start addressing the issue once it is visible in rural areas.   From 2016 to 2022 the number of locum contracts in GP surgeries increased 446% in all of Norway.  In rural areas the increase was 659%. In rural areas locums were covering positions for a shorter duration of time than in urban areas as they would need to cover 100% of a position, while locums in urban areas might be there for longer by often covering part-time. Locums are expensive with locum agencies earning large sums.  GPs can earn triple what they would earn if they were salaried and they can work more flexibly.   Rotational positions are a way of organizing general practice in areas that have been dependent on locums for a long time.  It is inspired by the off-shore positions in the North sea.  Doctors work 3 weeks on and then 3 weeks off.  Three doctors would then cover one full time position.  The municipalities have noticed that there are no applications for the normal salaried positions when they are advertised but when they advertise a rotational position they get 20 or more applicants.   Top tips: Seek a well functioning practice and a mentor Seek clinical courage,  curiosity and flexibility Potato ethics - doing things outside of your comfort zone because you are the only one that can do this Be involved in the local community, get to know where you live and work.   Norwegian Centre for Rural Medicine: https://www.nsdm.no/english/  Contact: https://en.uit.no/ansatte/anette.fosse   Thank you for listening to the Rural Road to Health! Rural Health Compass

Dr Rebecca Orr is an academic GP from Northern Ireland who focuses on farmers' health.  She is also the Chair of the Agri Rural Health Forum in Northern Ireland.  Episode Summary: 00.45  Rebecca tells us about her professional background and how she became interested in rural health and farmers health 04.00  What is the role of women in farming and the health of rural communities? 06.50  What is the NI Agri-rural health forum? What work do they do? 21.20  Why are you researching farmers' health? How important has it been to include farmers in the research process? 34.45  What were some of the key findings of her research? 39.25  What should clinicians be thinking about when they are caring for farmers and their families? 47.00  What are your top three tips for people thinking about going into a rural health career?   Key Messages: Even though about 86% of those in farming are men,  women have always played a huge role in farming.   The NI Agri-rural health forum started in 2021.  They have a role to bring everyone around the table to talk about health, they bring together agriculture, public health, voluntary sector, government and commercial organisations.   Key aims of the Agri-rural forum are to share information between the different stakeholders.  The forum holds panels, workshops, developing a network to help partnerships flourish.   Researchers have come to speak to the Agri-rural health forum, this has provided inspiration for other activities.   Decided to focus on blood pressure and cardiac health.  Teamed up with the British Heart Foundation to develop tailored health materials for farmers.  "You might know your tire pressure, but do you know your blood pressure".   Developed a 5 year plan for what they would like to work on next.  One of the next topics is respiratory health and occupational lung disease in farmers.   One of the challenges was to find a way to bring different partners together who may have different interests and targets, building trust is a big part of this process.  There is a gap in knowledge about farmers' health in the UK and Northern Ireland, especially linking it to primary care.  How does the change in farming practices affect farmers' health?  There is a divergence in mortality among farmers compared to the general population.   They got farmers involved in the research study. The question is: what factors influence the behaviour of farmers at risk of cardiometabolic disease?  The farmers informed the choice of the research methods and they were involved in the development of the survey.  They used the COM-B framework, farmers understood this framework and got behind it.   Farmers analysed the questionnaire, edited it together and they took ownership of the research protocol with the research team.  It has been important to give feedback regularly to the farmers (participants) on the progress of the research and the insights that were gained.  It is important to involve them in the discussions around how the data and insights are interpreted.   Farmers were asked to rate their top priorities, they responded with farm and family health and then personal health were their priority.  When asked what the priority of their peers is they answered farm financial health.     Key findings so far:   - Risk taking, one farmer said "we are actually gamblers". Does that feed into their choices around health? - Optimism - that thing will work out - Sense of responsibility - they take responsibility for optimised farm health -  Self-sufficient - feeling that they have to figure things out for themselves - Seasonality  - Planning   Advice for clinicians: Farmer clinic - don't need an appointment, they can just turn up  Be straight talking - if there is a risk they want to know about it in clear language Farmers experience life and death and are aware of the fragility of life and some of the physiology Trust - the clinician being seen as part of the community Ask about their work - will help you build a management plan Farmers are heavily influenced by family, think about the whole family context. Make the consultation count    Top three tips: Keep an open mind, rural health is full of variety. Chat to everybody, especially those who are not directly involved in healthcare. Have a flexible plan for the future, "if the plan is flexible you are always on plan".   Dr Rebecca Orr X: @rebecca0rr Email: [email protected]    Thank you for listening to the Rural Road to Health! Rural Health Compass

Melanie Costas is the founder of Rural Mental Health Matters, a social enterprise focused on tackling mental and physical health inequality in the UK.   Episode Summary: 00.45  Melanie tells us about her professional background and how she became interested in rural mental health 02.55  Why did she start Rural Mental Health Matters? 06.45  What does Rural Mental Health Matter do? 10.15  What are some of the challenges faced by rural citizens when trying to access mental health support? 14.45  What is it like when people do access local mental health services? 17.00  Is mental health stigma more prevalent in rural areas? 19.10  How much does social isolation contribute to poor mental health? 20.45  Are the mental health needs of the elderly being addressed? 27.15  What could we do to improve mental health access in rural areas? 29.40  Are there any initiatives that she would like to highlight? 32.55  How does disability impact rural citizens? 38.25  Who should be involved in discussions about disability and accessibility? 44.30  How could clinicians better support people with their mental health and disabilities?   Key Messages: "Save our mental health" was a campaign in North Dorset to highlight the issue of a lack of mental health services in the area following a review of mental health services in the region.  Received 800 responses to the government consultation, as a result a service was put in place in Shaftesbury (North Dorset). Rural Mental Health Matters is representing the rural voice in England and Wales.  They would like to have rural community wellbeing centers in larger rural towns and mobile outreach vehicles to go into more rural and remote areas.   Currently working on an accreditation for organizations that provide services that are rurally inclusive.  Many national organizations currently do not think about rural inclusivity.   Rural citizens are less likely to access services as they are further away, they have longer wait times to see GP and there is less opportunity to access support. Cuts to public transport have made services less accessible for many.   There is no mandatory mental health support for people following a cancer diagnosis.  The referral letter from the GP could include information about mental health support services. Cancer patients living in rural areas can find it very difficult to access mental health support.  More focus needed on mental health outreach.  Rural patients can be told that the service does not come out that far.   Because of the lack of visibility and accessibility of mental health support, rural citizens have expressed that they do not want to burden their family and friends, so they don't want to talk about it. Carers in rural areas take longer to travel between clients, they can see fewer people and they spend less time with rural clients.  This sometimes leads to rural people choosing not to take up those services.   Rural areas and local authorities receive less funding to provide care services.   Organizations need to focus on how they can be more rurally inclusive.   Rural people with disabilities can struggle to access nature, open spaces, and public buildings.   There is a lack of disabled parking, and other accessibility support, especially when we know that 1 in 5 people have a disability.  Organizations sometimes do not think about disabled access, having an elevator or ramp in the building is often not sufficient.   27% of the population has a visual impairment. More education is needed that develops understanding about the connections between mental and physical health.   Thank you for listening to the Rural Road to Health! Rural Health Compass

Dr Miriam and Malachy Dolan have a social farm in Northern Ireland.  We talk about social farming and how it can benefit farmers and rural communities.     Episode summary: 00.45  How Miriam became interested in rural medicine 03.15  How Malachy became interested in rural health and social farming 06.30  What is Dolans Social Farm? 10.30  Who visits the farm and what activities do they take part in? 12.50  How do people find out about the farm, how are they referred to the farm? 15.20  What are some of the benefits of social farming? 17.20  What role does social farming play in the wider community health context? 19.20  What kind of training is needed to open a social farm? 23.50  Do GPs know about social farming and do they understand it? 25.30  Are there benefits for farmers that choose to open a social farm? 29.25  Could any farm become a social farm? 35.05  What does a normal day look like at Dolans Social Farm? 39.40  What are the Dolans top tips for starting a social farm?   Key messages: Dolans Social Farm is a working farm with cows, pigs and chickens.  It is a place where people come, have cups of tea and do some work on the farm.  Different people visit the farm, they may have had issues on their life journey, mental health issues or an intellectual disability.  They can sometimes feel excluded from normal community life and on the farm they become part of the farm. The social part is key, a farm is a good place to create social inclusion activities.  Through the activities needed on a farm people can develop relationships.   Visitors to the farm do not have to work if they don't want to; they can just come and socialize.  One of the longest attending visitors comes to the farm and plays the guitar. There are no list of activities as it can depend on events at the farm, the season or the weather. People are referred to the farm through social workers or key workers that work with people with chronic mental health issues or learning disabilities.   Family farms already exist and they are assets in rural communities.  One of the biggest strengths of social farming is that you don't have to go out and build or create something new. A farm is a good environment for people that have had experience of life on a farm but are now experiencing something like dementia.  The farm helps them feel more settled as they feel that they are in a familiar surrounding while also being able to engage with others.   Farm families should already be trained in health and safety as this is relevant for all working farms.  Getting involved in social farming focuses the mind on what you should be doing anyway.   Social Farms and Gardens is a UK wide charity, representing 3000 members, 450 social/care farms. They offer training and there is a quality assurance system to make sure you are meeting the requirements of the visitors to the farm.   GPs want to know that if they signpost someone to a social farm that it is safe for their patient and that the service will be available over time.   Priorities for farmers are sustainability, productivity and succession.  Farming is a way of life.  It is a high pressure profession. Social farming is potentially another source of revenue for the farm.  It can help with succession as children can see that the farm is a vibrant, dynamic and social place.   Years ago farms were social places, now there is a lot of automation and you might not see anyone during your day.   Social farming puts the culture back into agriculture. Many of the visitors to the farm are also farmers.  They come to the social farm as they can meet with people who understand the farming lifestyle and the challenges they are facing.   Activities on the farm happen from 10am to 3pm, 4 days a week.  People are generally very respectful of the farm and personal spaces in the home.   Dolans Social Farm Social Farms and Gardens Get Green Care Quality Mark Framework European Federation of City Farms   Thank you for listening to the Rural Road to Health! Rural Health Compass

Catriona Crawford is a therapeutic radiographer by training, she is working with the Farming Community Network in Northern Ireland on the Rural Communities Cancer Project.   This project partners with Macmillan Cancer Support to raise awareness of the signs and symptoms of cancer, the need for screening, and support that is available following a cancer diagnosis.   Episode summary: 00.45  Catriona tells us about her professional background and why how she got interest in rural health 07.00  What is the farming community network? 09.00  What is the rural communities cancer project? 12.00  Why was this project started? 15.30  What barriers exist for cancer care in Northern Ireland?   25.00  What is the project hoping to achieve?  29.25  Who else is getting involved in the project and what kind of partners are they looking for?  34.30  How can people support the project?   Key messages: Rural patients (farmers) may choose to stop treatment due to the feeling of isolation and feeling far away from home.  Often they have to travel long distances far from support networks, family and friends.   The farming community network is a voluntary organization that aims to improve the health and wellbeing of farmers.  It is located throughout England and Wales, starting up in Northern Ireland and Scotland.  Charity set up for farmers, by farmers.   Confidential national helpline for farmers which is available to anyone anywhere in the UK.   Rural communities cancer project is a UK wide partnership with UK Macmillan cancer support.  Aims to raise awareness of cancer among farming communities and improve the knowledge and understanding of cancer in communities.   Macmillan found that rural patients were not uptaking support that they were providing for cancer patients. Farmers can refuse treatment if they are worried about side effects affecting their ability to continue working on their farm.  This has led to farmers stopping or not starting cancer treatment resulting in poorer outcomes.  Northern Ireland strategy for cancer care highlighted three main barriers to cancer care for rural communities: 1) access to services, 2) access to travel and 3) scheduling of appointment times. Available research and data does not reflect what is seen in practice and what is happening in rural communities.  We need better statistics on late cancer presentations based on geography or data on the psychological and financial impact of having to receive treatment far from home.  How many people from rural backgrounds are not accessing support services? There is a lack of understanding and awareness of the signs and symptoms of cancer, the project aims to improve this and help people understand what Macmillan cancer support does.   It is important to target locations that farmers go to such as sports clubs, schools, and agricultural shows.   It is important to understand that these communities engage with people and organizations that they trust.     Farming Community Network: https://fcn.org.uk/ Macmillan Cancer Support: https://www.macmillan.org.uk/  Contact Catriona: [email protected]    Rural Health Compass - Navigating rural health and policy. Thank you for listening to the Rural Road to Health! 

13th EURIPA Rural Health Forum Highlights   Lincoln Institute for Rural and Coastal Health: https://www.lincoln.ac.uk/shsc/research/lirch/ Campus for future livingin Mablethorpe: https://connectedcoast.co.uk/project/campus-for-future-living/ Credential for rural and remote health: https://www.scotlanddeanery.nhs.scot/media/722082/final-credential-curriculum-in-rural-and-remote-health-submission-triangulated-submission-250823-v20.pdf   WHO Primary Care Toolkit: https://www.who.int/teams/integrated-health-services/clinical-services-and-systems/primary-care WHO Health Equity: https://www.who.int/health-topics/health-equity#tab=tab_1   EURIPA Lincoln Statement: https://www.euripa.org/news/view/euirpa-lincoln-statement-2024-tackling-rural-health-inequity-in-europe    Rural Health Compass - Navigating rural health and policy. Thank you for listening to the Rural Road to Health! 

Dr Madeleine Muller is a Family Physician and Senior lecturer at Walter Sisulu University and she serves on the RuDASA (Rural Doctors Association of Southern Africa) executive committee. Episode summary: 00.50  Dr Muller talks about her journey into rural health 04.15  What were the challenges of working with patients with HIV/AIDS in rural areas? 07.40  What impact does mentoring have on providing services in rural areas? 10.30  How did RuDASA start and how did it develop? 15.00  What tools and resources has RuDASA developed?  What is the rural onboarding program? 22.00  What kind of training do medical students receive in South Africa? 27.40  How did RuDASA get more involved in advocacy? 32.00  Have there been issues with supporting advocates? 35.30  Has RuDASA had an impact on recruiting and retaining rural clinicians? 37.30  What has Dr Muller enjoyed most about working in rural health? 38.35  What are Dr Muller's top three tips for people thinking about a rural health career?   Key Messages: Major HIV treatment program rolled out in South Africa - mentoring and training was needed to help implement this program effectively. About 7.5mil people in South Africa are on ARVs, with 70% of the population living in rural areas. All of these people need to travel to clinics to collect their medication every month.  Patients need to be monitored for side effects and pick up problems early.  Logistical challenges in rural areas that do not have easy access.   The more rural the area the more difficult it is to get clinical staff to go there.  There are fewer resources and infrastructure.  High turnover of young staff coming and going. RuDASA founded in 1996, created as a support network by doctors passionate about rural health.  It can be isolating and lonely and this support was important. RuDASA holds an annual conference, doctors gather and talk about what they are up to and the challenges they are facing.   Doctors can feel lost and like they do not have the training, backup and support that would be available in a bigger city. Zoom and internet connectivity helped support the development of training and mentoring that was not possible previously.  This has made rural health more attractive. RuCASA - rural clinical associates RuNASA - rural nursing  Rural Health Alliance launched through Rural Health Advocacy Project, they have joined all the organizations that are passionate about rural health to create one voice for rural health. The National Health Insurance Bill has been passed in South Africa recently, it has been controversial.  RuDASA and the Rural Health Advocacy Project have been involved in giving input and applying rural proofing. In South Africa, all young doctors need to spend one year at a rural facility.   They are suddenly dealing with a variety of high stakes medical situations with limited resources. RuDASA has developed an onboarding program to help support them in their role.    About 50% of the doctors joining the onboarding program are new young doctors, however 50% are more established rural doctors who are using this to update their knowledge and connect with colleagues. South Africa has a 2 year internship, this covers different surgical and obstetric skills.   They have been using online tools to link clinicians to specialists.  As a group of doctors we know more, on our own we will never know everything. The difference between rural health being somewhere where you can thrive or where you are barely holding on with your finger nails is having support available.  This has been the real benefit of RuDASA, no one needs to feel they are going at it alone.   Public health systems make "complaining" about things that are not working very difficult.  They operate as closed systems and it can be difficult to raise concerns without damaging professional relationships. Rural Health Alliance can give a voice to what they see but it is not one person speaking out leaving them in a vulnerable position.  Doctors can get on with their job and the Rural Advocacy Project can write the press statements and give input on public discourse.   Healthcare everywhere struggles with human resources, that gap is much bigger in a rural area then an urban area.  If two doctors leave a rural area this could represent 25-50% of all the doctors which has a much bigger impact on the provision of healthcare in rural areas.   Doctors who are passionate about rural health create the conditions to inspire new clinicians to work and stay in rural areas.  RuDASA gathers these passionate people together. To be able to love what you do and thrive in a place you have to feel like it is your calling.  Three components - feeling that what you are doing makes a difference, feeling competent at what you do, and feeling appreciated.   RuDASA website RuDASA Resources Contact Dr Muller: [email protected]   Rural Health Compass - Navigating rural health and policy. Thank you for listening to the Rural Road to Health!   

We speak with a nurse practitioner who has experience working with victims and survivors of modern slavery in the UK.   Episode summary: 00.45 Our speaker tells us about her professional background and how she developed an interses in modern slavery 04.15  What is modern slavery? 06.45  Where does modern slavery happen and does it affect rural communities? 09.00  Who is most at risk of human trafficking and modern slavery? 10.30  Who are the traffickers? 12.40  How would we identify modern slavery? 19.30  How do we approach consulting a patient who we suspect is a victim of modern slavery? 27.30  What happens after a person has been referred to adult safeguarding? 29.35  How could we support survivors of modern slavery? 33.15  Where can we learn more about trauma-informed care?         Key Messages: Modern slavery is a situation where individuals are exploited through coercion, force, and deception for various purposes.  The main purpose of the traffickers are benefits such as money. People would not always know they are being trafficked because of the deception and lies.  They would only suspect it once they find themselves in difficult situations. 50 million people globally have been trafficked. It is difficult to know the exact numbers due to the nature of trafficking.  In the UK,  in 2022, more than 10 000 people were identified by the Home Office as victims of trafficking.  The true numbers are suspected to be much higher than this.   Modern slavery can happen anywhere including rural communities.  It is much more hidden in rural communities, particularly in agriculture.  The main reason for human trafficking and modern slavery is poverty. People more at risk of being trafficked are those with less social support around them, people with people dependent on drugs or alcohol, people living in extreme poverty, and undocumented migrants - people who are part of vulnerable groups. Traffickers are clever and know who can be easily influenced into their businesses.   A victim of modern slavery might not know they are in that situation as they do not know what kind of conditions they should expect.  For this reason they may not know to ask for help. It is much more difficult for victims to be identified in rural areas.  Farmers and agricultural employers need to be on the lookout for unusual employment and recruitment practices.  Other signs can be unusual living conditions, limited freedom of movement, being closely monitored when they do move outside of their working or living areas, isolation, signs of abuse, malnutrition and untreated medical conditions, working long hours in hazardous conditions, little control over personal finances or possessions, fear and anxiety - may be very reluctant to talk to authorities or seek help.   Important for GP practices in rural areas to have training in identifying the victims of modern slavery, they have a crucial role in identifying these individuals.  Take special care when you are seeing someone who is accompanied by another who refuses an official interpreter and insists on being present in the consultation.  Trust your professional instinct and arrange a follow up appointment to explore further.   What to do if you suspect a patient is at risk of modern slavery? Make sure you are safe, stay calm, try to talk to them on their own and try to address their health needs. Alert your colleagues.  Ask for an interpreter.    If you are safe to do so, ask the accompanying person to leave, and try to examine the patient on their own. Try to make the person feel safe, build trust. Do not ask them about their immigration status, focus on their health needs and ask them what they want. Arrange a follow up appointment if requested or you assess it is needed. You must ask the person if you can refer them to the adult safeguarding team. If a child is involved then a referral is made immediately.  Once they have given you the permission then you can refer them to the adult safeguarding team. If you are unsure contact the national modern slavery helpline or police (anti slavery unit). Trauma-informed care is important for survivers of modern slavery and human trafficking. Culturally sensitive care is also vital as it is part of making the person feel safe.     Rural Health Compass - Navigating rural health and policy. Thank you for listening to the Rural Road to Health! 

Dr Roxana Surugiu is a family doctor, researcher and lecrurer at the University of Medicine and Pharmacy in Craiova in Romania.  In this episode we learn about rural health in Romania and the findings of her research on the perception of rural practice among medical students in Romania. Episode Summary: 00.55  Roxana tells us about her professional background and how she got involved in rural health 02.30  What is family medicine training like in Romania? 05.00  Are medical students exposed to rural practice during undergraduate training? 06.10  How is primary care organized in Romania? 08.30  What are the challenges that the rural community faces and what are the challenges for the clinicians? 12.15  What happens in emergency situations?   14.30  What does a usual work week look like? 18.30  Has rural digital health been developed in Romania? 21.45  What were the findings of the research on medical student perception on rural health? 28.20  What is the perception of family medicine in academic circles? 31.30  What are your top three tips for going into a rural health career?   Key Messages: Family medicine residency training lasts for 4 years in Romania, two years are spent in family medicine and there is a 2 week rotation in a rural practice.   Medical students spend one month in family medicine during the 6th year of medical school, they will usually have one or two weeks in a rural practice. Distance, education and low socioeconomic status can present barriers to accessing healthcare. The local primary care team where she works have made efforts to improve healthcare understanding and provide information to patients.   The primary care team provides emergency care and out of hours care, when there are more serious emergencies the ambulance service can take the patient to hospital when needed.   The primary healthcare centers in Romania are staffed 24h a day by family doctors.  Student exposure to rural practice increases interest in rural medicine and increases their medical skills. Family medicine was not a choice for older family medicine doctors, it just happened to them.  This has given family medicine a negative perception among medical specialties.  Additionally there is a final exam which is scored and based on this it indicates what specialty you can do.  Lower scores are needed to go into family medicine residency and this also leads to a bad perception of family medicine. Exposure to family medicine and rural medicine is very important as a way to improve the perception of these specialties. A rotation into rural practice in the final year of medical school has only been happening for the past few years.  There is still a long way to go to improve student exposure to family medicine and rural practice.  Exposure should happen at an earlier stage of training.  Top 3 tips: Have an open mind.   Build a relationship with the community and gain their trust. Seek continuous education, be exposed to conferences, academic environment and learn from your patients.   Rural Health Compass - Navigating rural health and policy. Thank you for listening to the Rural Road to Health! 

Dr Giovanni Baglio and Monica Brinzac join us to speak about the OASES project, a EU funded project looking at medical deserts in Europe.     Episode summary: 00.50  Dr Giovanni Bagglio and Monica Brinzac tell us about their professional backgrounds and projects they are involved in 04.40  What is the OASIS project? 06.25  What are medical deserts? 10.30  How many areas of Europe are affected by medical deserts?  13.40  What were the main goals of the project? 15.55  Who was involved in the project? 18.30  How were rural communities involved in the project? 20.05  What has the impact been for rural communities? 22.40  Is there a good understanding of the problem among urban stakeholders? 25.25  What were some of the key findings from the pilot studies? 31.10  What do they see as the next steps that are needed to address medical deserts?   Key Messages: OASES is a project that aims to define and share methodologies and knowledge on how to measure medical desserts in order to develop common policies and strategies to address these challenges.   There were seven European countries participating in the project: Italy, France, Cyprus, Romania, Moldova, Hungary and Finland. Other EU  projects that are relevant are: AHEAD and ROUTE project which also address the issue of medical desserts;  METEOR ,focused on retention of healthcare workers,TASHI on task shifting. Medical deserts are a complex phenomenon.  The project has adopted a composite definition:  Any situation where criticalities arise in the relationship between health needs, demand and supply of healthcare.  This includes not just the lack of health services but also situations where the quality of care is poor or certain populations do not have adequate access. There are 3 dimensions that were explored: 1) availability, 2) quality, 3) accessibility and equity.   From this a matrix was developed with specific indicators. Each medical desert is unique, however they do have similarities such as the shortage of medical doctors in rural areas, and difficulty to access care due to an unequal distribution of services. OASES aimed to provide a clear idea on the current situation in regard to medical desertification.  They then developed a set of measurement methods to ultimately develop a common language in Europe and try to address the challenges with common policy approaches.   There were diverse partners, health systems and stakeholders that took part in the project, this was a strength of the project.   We may all be living in a medical desert in 10 years time as it is projected that 40% of the current healthcare workforce will retire within that time.  The project included communities and they discovered that the rural communities are the most disadvantaged as they have fewer healthcare facilities and fewer healthcare workers.   Delayed access to care leads to worse health outcomes.  This also increases the costs for the health system. One of the mitigation strategies that has been proposed is to offer financial incentives to medical professionals working in rural areas and to invest in improving the infrastructure in rural areas.   This challenge needs to be tackled at all levels, with a bottom-up and top-down approach.   Recommendations:  Increase the number of healthcare professionals.   Expand the role and scope of healthcare professionals. Financial incentives. Reorganize primary care delivery. Policies that support a well functioning health system. Utilizing digital technologies. The biggest issue is the number of healthcare professionals as the majority of countries have an insufficient number of healthcare workers.  Resources that do exist are not being utilized effectively.  If people do not have access to a good quality service they will not choose to access it.  Quality is important. There is a lack of reliable data to draw conclusions from. Next steps involve implementing actions and recommendations and we need better data.     Thank you for listening to the Rural Road to Health! 

Dr Wiktor Szczudlinski is a general practitioner who qualified in Poland and is now working in Scotland.  He shares his experience of working as a rural GP, why he decided to leave rural practice, and how he has gotten more involved in health tech and consulting with health tech start-ups.   Episodes summary: 00.40  Dr Szczudlinski talks about his experience moving from Poland to rural Scotland 03.35  What were the challenges while working in rural Scotland? 05.30  Who were the members of the wider healthcare team? 08.30  Were there any specific challenges to caring for the local community? 10.15  How was the work different in the summer compared to the winter? 11.30  How would you compare rural and urban practice? 15.30  What factors influenced his decision to move to a more urban area? 18.30  Why did he decide to become more involved in health tech and entrepreneurship?  22.00  What has he learned about health tech?  How can digital solutions be implemented in rural areas? 35.50  Top tips for people thinking about a rural health career     Key messages: Mixture of work as a rural GP - usual GP clinic, out of hours/urgent care, and working in a small local hospital. Support via telemedicine with a larger hospital center and good connections with emergency retrieval services. The job provides a lot of variety, you are well supported and feel part of a team. Local community works in professions where there can be serious injuries.   People can present late with symptoms as they often try to carry on, this can lead to more advanced  No additional staffing in the summer despite an influx of tourists.   Workload is different in urban vs rural - people assume that the workload will be less in rural areas, this is not the case, distances make a difference, it can take a long time to do a home visit.  There can be a lack of infrastructure such as mobile network access, this can make it challenging to call for help in an emergency and it can take longer for help to arrive.  Fewer resources are available in rural areas.   The assumption that it is less busy in rural medicine is not the case, the number of the tasks may be lower but the time needed for those tasks is longer.   You need to be more confident in your skills and go outside your comfort zone, there is a big element of urgent and emergency care.  You need to be prepared - anything could happen. Family factors played into the decision to leave rural practice and move to a more urban area.  Housing is a big problem in rural Scotland. When AI started becoming more prominent he started learning more about this, writing about what he was learning on LinkedIN.  Started to be contacted by health tech founders and started consulting and sharing his healthcare experience. Doctors often do not pay attention to things outside of medicine.  It can be important to step out of your comfort zone and learn something new. We need to pay attention to what is happening with tech and AI as we will be seeing more of that.  There is scope for these tools to free us from mundane tasks and paperwork.   Digital solutions may be implemented faster in rural health as there is a long history of using telehealth in these areas.   There is a need for digital solutions in rural areas as there is a lack of doctors, this can be a solution to help provide care with the support of other members of the healthcare team. When the only doctor on the island gets snowed in for a few days, the only solution is to provide remote digital consultations.   Give rural medicine a try, it can be an adventure in beautiful surroundings and you become part of the community.     Thank you for listening to the Rural Road to Health!

Dr Jaka Strel is a rural family doctor from Slovenia.  Dr Strel and his team have built a very successful medical practice in Ziri, which has helped Ziri win the title of healthiest municipality in Slovenia. Episode summary: 01.00  Dr Strel shares his journey into family medicine and rural health 05.15  Specialization of family medicine in Slovenia 08.45  How is the primary care system organized in Slovenia? 14.20  Who are the members of the family medicine team? 15.00  What are the characteristics of the community he is caring for? 19.45  What challenges is rural medicine facing in Slovenia? 21.40  What health challenges to rural communities face? 22.30  What is different about the approach they are taking in Ziri? 27.00  How did they make Ziri the healthiest municipality in Slovenia? 31.30  Who were the key partners to make this approach possible? 34.30  Were there any barriers and challenges to trying this new approach? 38.00  Will this approach with a focus on preventative care be expanded nationally? 39.35  How has the community responded to this approach? 40.30  What lessons has he taken from this experience?   Key messages: His rural family mentors during his early years of training influenced his choice to become a family doctor. Health system is organized into three levels: primary care, regional hospitals and tertiary centers. Primary care includes family medicine, pediatrics, gynecology, dentistry and emergency medicine.   Primary healthcare is organized around 60 healthcare centers, under the auspices of local municipalities. "Concessioners" are doctors that have a contract directly with the National Health Insurance Company.  They can work within the local healthcare center. 20% are rural clinics, most of them are located in health stations which are part of health centers.  Some rural clinics are run independently by concessioners. First health center in Slovenia was established in 1930 with the goal of uniting providers for primary care and preventative care. The community has a positive attitude towards sports and physical activity which has been accredited to the local primary school and the educators there.   There is a lack of rural medical education, at present education in this area depends on good rural mentors.   There is no extra funding provided for rural practice despite there being higher expenses for work in rural areas. Two challenges for the health of the community have been alcohol abuse and bone fractures in the elderly. They work with different partners within the community such as the local government, schools and other community organizations. Three important areas that they work on: prevention, flexible curative healthcare, good information support and optimized processes.   ZirFit - a health promotion activity organized with sport experts, primary school leaders and people from industry.  Organized measurement of 12 parameters of physical fitness such as strength, balance and agility.  This happens every year on the third weekend of May.  Usually attended by about 100 people.  After the testing the patients receive advice from a kinesiologist and doctor on how to optimize their health.  This is the key to success - working with the community.  The health center has made significant improvements to the health of the community - lower overall mortality, higher vaccination rates, high participation rate in preventative programs.   Local companies, sport clubs, and community clubs were important partners who helped to support this approach to community health.  Relationships were established through individual meetings.  It is important to be patient and think about the perspective of the people you are talking to so that you can find a united way to work on things with the community. It is important to meet regularly with all of the community partners. There are always challenges, especially when you are doing something new. Biggest challenge was to find suitably motivated colleagues with the right professional knowledge and personal qualities.  Decided to grow the team gradually.  It is important to have a good team and take care of their wellbeing and opportunity for personal and professional development.  Challenge of COVID-19 pandemic, stopped many preventative activities. Challenge with funding of their programs for preventative care as there is no national system funding for these activities.  They have had to find alternative sources of funding to do this. There has been a positive response from the community.   Lessons that he has learned on this journey: The importance of having a supportive family and team, colleagues that you can rely on.  There  is always a way forward, perseverance and some times stubbornness is necessary. Patience and prudence.     Top tips for people thinking about a rural health career: Take care of yourself.  We work hard and we have to rest both physically and mentally.  Take care of physical fitness and mental health, it is essential Have a hobby that relaxes you and helps you clear your mind. Important to have a team of colleagues who are prepared for different scenarios, that are dedicated to their work and are adept at collaboration.   Collaboration with the local community is crucial.  Relationships with the community must be nurtured.     Thank you for listening to the Rural Road to Health!

Melanie Hartmann is a healthcare worker with a bachelor degree in interdisciplinary healthcare and management from Germany. She has been reseaching primary care netwroks on the Halligen Islands.  She talks about the unique way in which primary care has been organized on the Halligen and the insights that she has gained during her research.   Episode summary: 00.55  Melanie tells us about her professional background and how she got involved in rural health 02.50  How is primary care organized on the Halligen Islands? 06.20  What are the characteristics of the community? 09.10  What are the different roles of nurses on the Halligen? 11.30  How do nurses reach the people on the smaller islands? 13.30  What are the challenges to access healthcare? 16.15  What challenges do the nurses face working on the Halligen? 19.55  Melanie talks about the research that she has been doing about primary care on the Halligen 25.00  How does local identity impact the provision of healthcare? 27.00  How does local culture and identity affect healthcare workers that are coming to work in these communities? 29.00  Top three tips for people thinking about a rural health career   Key messages: There are no doctors based on the Halligen, they visit once every two weeks.  Nurses lead the primary care on the Halligen for a population of about 300 people.  In summer there are a lot of tourists, this is important when considering the healthcare that is needed during the summer months.  The population can more than double.  In winter fewer ferry connections to the mainland than in the summer.   Nurses are the most important interface between primary and secondary care, they are parts of the community.  They rotate every 2 weeks on the larger islands and they are present on the island 24/7.   First aid responders (members of the local community) exist on the smaller islands and they have some limited equipment available and provide basic emergency care while waiting for further help to arrive.  Leaving your home to receive healthcare requires a great deal of effort, personal and cognitive resources - not everyone has these.   The community on the Halligen were the first community to be fully vaccinated for COVID-19 as the nursing team knows the community and where everyone lives. Nurses that work on the Halligen are highly trained.  They are all emergency nurses and have developed further skills on the job.  How can networks help to secure healthcare and how can they make healthcare better? On the Halligen the importance of community nursing is on full display.   Local identities are important, there are those that have lived there for a long time and those that have recently moved there.  This results in very different expectations from healthcare.  Every community has its own identity.  You have to find a shared goal with the community. It is important to have a good understanding of the local environment and the social determinants of health that impact on the community and individuals.  Top 3 tips: 1) Look at and understand the community identity on site as you are often an outsider.  2)  Develop trust. 3) Prioritize goals which connect with the identity of the community.   Thank you for listening to the Rural Road to Health! Rural Health Compass - Navigating Rural Health and Policy

Dr Bita Barghchi is a primary care doctor from Iran.  In this episode she shares her experience of working in rural Iran and talks about some of the challenges faced by rural communities and healthcare workers.   Episode summary: 00.45  Bita tells us about her professional background 01.45  How is the primary care system organized? 03.15  How do patients access secondary care and other health services? 05.40  What were the characteristics of the community Bita was working in? 07.50  How were emergency cases managed? 11.40  What are the main challenges facing rural communities in Iran? 13.45  How are healthcare workers managing the high workload and burnout? 19.00 What has the transition been like to Australia?  What are some of the differences between Iran and Australia?    Key messages: Health houses with qualified GP, nurse and midwife make up the core primary care team. People do not like to be referred to secondary care as this often incurs a payment for the service. People can choose to visit a specialist without getting a referral from primary care.  This can lead to visits to the wrong specialist. Important to be patient when working in rural areas and develop a good relationship with the community. More health education needed for school aged children.  Poor coverage for women's health.  High levels of suicide among doctors in Iran, particularly among younger doctors.   Pressures on the workforce are leading to health workforce migration. One of the biggest differences between Iran and Australia is that all patients, including women, are able to make decisions about their health.  Important to be patient and respectful towards rural communities, be adaptive, and develop good relationships.    Recent article about doctor suicide in Iran: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00530-0/fulltext   Thank you for listening to the Rural Road to Health!

Prof John Wynn-Jones and Prof Mark Gussey are the co-chairs of the 13th EURIPA Rural Health Forum which will be held in Lincoln in June 2024.  They will tell us more about this upcoming event and their aspirations for the Forum.   Episode summary: 01.15  Prof Gussey shares his journey into rural health 03.40  Prof Wynn-Jones shares his journey into rural health 06.55  What is EURIPA? 08.15  What is special about EURIPA Rural Health Forums? 09.35  Lincoln and the International Institute for Rural Health 13.15  What does the Institute mean for rural health in Europe and beyond 16.40  What is the theme of the EURIPA forum? 19.25  What should rural primary care focus on in tackling inequalities?  21.25  What is in store for the social part of the EURIPA Forum? 26.15  Who is the Forum for and who should attend? 29.45  What do the Co-chairs hope will be the outcomes of the EURIPA Forum? EURIPA Rural Health Forum - Lincoln, UK June 20-22 2024 Theme: Tackling Health Inequalities in Rural and Remote Communities https://forum.euripa.org/   There are 4 bursaries available for students and young doctors.   Keynote speakers:  Dr Toni Dedeu - Senior Advisor for Integrated Primary Care with the World Health Organizations Dr Pauline Wilson - Consultant Physician on the Shetland Islands   Abstract submission open until 7th April. Early Bird registration until 19th May. Thank you for listening to the Rural Road to Health!

Prof Lionel Green-Thomson is the dean of the Faculty of Health Sciences at the University of Cape Town in South Africa.  He is also a member of the board of directors at the Network Towards Unit for Health.  We will be talking about the upcoming Ubuntu 2024 conference.  This conference is jointly organized by 5 Universities in South Africa, Rural WONCA and the Network Towards Unity For Health. The theme of the conference is People, Place and Policy for Community Wellness. Ubuntu 2024 will be held in Cape Town, South Africa from the 10th to 13th of September 2024. Episodes summary: 01.15  Prof. Green-Thomson tells us about his professional background 04.45  What is the Network Towards Unity for Health? 08.05  How is the University of Cape Town involved in rural health training? 13.30  What is the story behind Ubuntu 2024? 19.15  What is planned for Ubuntu 2024 and how will people, place and community for wellness be explored? 23.35  Who is Ubuntu 2024 for, who should attend? 28.10  What social events are planned for Ubuntu 2024? 32.15  What does Prof Green-Thomson hope for as an outcome of Ubuntu 2024?   Key messages: The Network Towards Unity for Health - a network of networks.  It provides education, building social accountability measurement tools, and provides a social accountability fellowship.  It has vibrant student involvement and engagement.  A person is a person through other people - Ubuntu. Communities have said that future clinicians need to learn about Ubuntu -"if this is not taught how will they love and respect us?" Increasingly recognising that the stories of indigenous people have not been told. Social and health policies for public good - can we put the ideas of health into every policy that governments and institutions create. The ongoing challenge is educating the health workforce. We get caught up in the quality but do not always wrestle with the relevance as much as we should.  Addressing power dynamics within the workforce.  Addressing social and environmental sustainability will be an important theme.  Ubuntu 2024 would like to see a strong community voice at the event, people from community organizations, indigenous communities, policy makers and people living and working in different regions of the world.    Ubuntu 2024: https://ubuntu2024.com/ The Network Towards Unity for Health: https://thenetworktufh.org/ Rural Wonca: https://www.globalfamilydoctor.com/groups/WorkingParties/RuralPractice.aspx  Rural Seeds: https://www.ruralseeds.net/ Student Network Organization: https://snotufh.org/   Thank you for listening to the Rural Road to Health!

Prof Nuno Sousa is a neuroradiologist and the Director of the P5 Digital Medical Centre in Portugal. This centre has been developing digital health solutions to support the provision of healthcare in rural areas in Portugal. Their projects have been developed in close collaboration with the local communities they work with.  Episode summary: 01.00  Prof Sousa tells us about his professional background 06.00  What is P5 and what work has been done there?  09.20  What types of services are being provided?  20.10  What have the benefits been for rural communities? 26.30  Who have been the local mediators in rural areas?  28.50  How many consultations are provided?  31.15  What has the response been from the health providers?   34.45  Have there been challenges within the health system? 39.45  How do we scale and spread innovation?  43.45  What are some key insights from Prof Sousa's research about aging? 54.15  What does Prof Sousa see for the future of digital health?      Key messages:  Created a clinical digital center (P5) to work in partnership with other healthcare providers and the local communities.   P5 is a way to give back to the community within which the center is working.  Embedding digital tools and technologies within the way we practice medicine. Three main goals of P5: 1) to ensure that medical students are trained in a digital health setting, 2) reaching further and improving the quality of care, 3) promoting research.   Empowering patients is at the core of what P5 is doing.   Promotion of health - engaging with local institutions, such as schools, to tackle issues that these institutions ask for help with.   Large demographic shift is happening in Portugal, emphasis on promoting healthy aging programs to improve quality of life.  Health promotion activities are run in parallel with activities for health literacy and digital literacy.   Integrators of solutions rather than creators of new solutions.  They have searched for solutions that already exist that can be adapted to the local context.   Digital palliative care program - multi modal program adjusted both to the patient and the caregiver, currently in the pilot stage. Allows for continuous monitoring and support.  Initial meetings/consultations should still be face to face to help develop trust and this allows for better integration with the digital services.   Establishing partnerships with local municipalities has been important to the success of the program.  Digital removes the barrier of distance.   People prefer to express themselves in their mother tongue when they are unwell, for this reason P5 provides services to patients around the world. People who use the services in urban areas are much younger than the people who use the services in rural areas.  In rural areas the interaction is not as easy due to technical obstacles such as digital literacy.   P5 has been meeting local people in local parishes, libraries and pharmacies to develop local mediators for communication to help people use the digital services.  The acceptance of the services can be slow.  P5 does not provide acute care, they focus on health promotion and monitoring of chronic decisions.   Local champions help to spread the word and support the adoption of the service.  Adoption is always growing but is very slow.   Mental health support has had good adoption particularly among younger people.   With older people the use is tied to the recommendation of the local health provider as there is an element of mistrust.   They found it was very important to engage with health professionals from the start and include them in the development of the program.  If this was not done the engagement with the services were not very good.   Digital literacy also needs to be developed among healthcare professionals.  New services need to reduce workload of healthcare workers not add to existing workload, this causes barriers to implementing new services.   Digital health is still seen as a side element and there are major barriers to integration.   A need for more tolerance and flexibility when looking at innovation. The health system can be very rigid which slows down the process of innovation.   Implementation science around healthcare services and processes is important if we want to move ahead.  The problem is if we are rigid in only giving one option of implementation, this can lead to dead ends.  Developing an ecosystem that allows them to explore healthy aging of the brain.   Could we develop interventions that improve mood which would improve cognitive function?  Social isolation negatively impacts cognitive function, it can decline dramatically in a short period of time.  Digital tools are not the enemy but the way for us to more effectively reach more people. P5 had built on the process of P4 medicine and added proximity.     P5 website: https://www.p5.pt/    Please like and share this episode.  If you want to learn more about the podcast go to theruralroadtohealth.blog  To share comments or reach the host: [email protected]  Thank you for listening to the Rural Road to Health!  

Dr David Halata & Dr Katerina Javorska are rural family doctors form Czechia. Both of them have been involved in an initiative to improve rural healthcare in Czechia called Go Rural. Dr Halata is the chairman of the Working Group for Rural Medicine in the National society for Family medicine and creator of Go Rural. Dr Javorska is a member of the Working Group on Rural Medicine and has been working with students and young doctors in the Hradec Kralova region. Episode summary: 00.50  Dr Halata and Dr Javorska tell us how they became rural family doctors and their professional background. 06.20  How is the primary care system organized in Czechia? 11.50  What are the rural health challenges? 17.15  Why did they start a rural health working group in their national society? 20.35  What is Go Rural? 23.55  What have the outcomes been from Go Rural? 28.30  Project in Hradec Kralova 36.00  Where there any challenges to developing the program? 37.20  Is the program having an effect on the development of rural health? 38.45  What have you learned from these projects? 44.15  What is their advice to others who would like to set up similar program? 48.50  What have they most enjoyed about being a rural doctor and their top tips?   Key messages: Primary care - primary care pediatrician, family doctor, primary care gynecologist, and dentist. Family doctor team was traditionally made up of a doctor and a nurse.   More recently some practices have started to develop primary care teams with additional staff. There are two different health care systems, one around university hospitals and another around local hospitals.  Availability and quality of care varies in different parts of the country. Challenges in providing care for Ukrainian refugees, it was important to build trust with them to provide them with good quality care.  Lack of rural GPs, senior colleagues have retired and no new doctors have taken their place.  This has left a lot of patients without a GP. Many issues faced in rural areas internationally are similar such as the shortage of rural GPs.   The Working Group for Rural Medicine was established in 2016.  It was important to base their work on data, a lot of things had been made on assumptions rather than data.   Go Rural started in 2018 and focused on students and young doctors to address the rural doctor shortage.  Survey showed that money was not the main motivator, other factors like schools for their children and jobs for their partners were more important.  The pilot program was focused on promoting rural medicine and organizing short fellowships in rural practice.  There has been a high interest from medical students for the short rural internships.   Longitudinal rural clerkships have been shown to attract doctors to work in rural areas. These are not available at present. The pilot program of Go Rural was run without funding and expenses were covered by the family doctors who were hosting students.   Finding the right mentors to host students was very important to showcase positive examples of rural practice.   Hradec Kralova Project received some funding from the local government, this supported the development of the project by covering costs for mentors, and allowing students to attend a conference. The project started with 15 participants.  Students were surprised by the variety of clinical presentations and work in rural practice.  These projects have helped to support further development of rural health in Czechia and they are now applying for a grant to start a national program. Following the projects a number of participants became rural doctors.   Larger resources are needed for nationwide impact.  The smaller projects showed that the approach was correct and effective.   There is a need for research in rural practice and good collaboration with universities. With data they were able to approach the ministry and ask for their support.  Without the data this would not be possible. A focus on GP trainers is needed in the future and develop them as teachers in general practice.  Advice for starting a similar project: Important to engage and identify the needs of young doctors.  Collect data from the local context. Focus on the quality of the internships and the mentors.  Involve them in real rural work.  The project needs to be fun for students and young doctors.  Engage students in promotion of the project and involve them in project development. Focus on international cooperation and events.     Contact information:  Dr David Halata: https://www.facebook.com/ordinacehostalkova/ Dr Katerina Javorska: https://javorskysro.cz/    Please share and like this episode.  If you wand to learn more about the podcast or share any comments you can do this via email [email protected] or at theruralroadtohealth.blog  Thank you for listening to the Rural Road to Health!

Dr Sara Bradley is a postdoctoral researcher at the University of South Wales. Prior to this position she was a postdoctoral research fellow at the University of the Highlands and Islands, in Scotland working in the Division of Rural Health and Wellbeing.  Her work focuses on social prescribing, rural service provision, mental health and wellbeing and community engagement and co-production. Episode summary: 01.00  Dr Bradley shares her professional journey 02.30  What is social prescribing? 04.40  What kind of social prescribing has there been in the highlands and islands of Scotland? 07.05  Why is social prescribing administered by volunteer and community groups? 08.00  What are the challenges for rural and remote social prescribing? 11.05  What were Dr Bradleys key insights from her research? 15.30  Examples of how social prescribing helped a community 19.00  How does social prescribing integrate with the primary care system? 22.45  What would need to happen to make social prescribing more sustainable in rural/remote areas? 22.20  Does social prescribing depend on the local community? 26.30  What motivates the third sector to work on social prescribing? 28.20  Are there resources for rural prescribing?   Key messages: There are a lot of non-medical factors that affect peoples' health and wellbeing. Social prescribing tries to address these non-medical factors, it is a holistic approach of trying to tackle these factors in the community and with the community.  Increasing confidence and self esteem allows participants to go on to do other activities and become more active in the community.   Social prescribing does not fit into conventional healthcare culture so there is a lack of capacity and funding within the system, for this reason third sector organizations take on these activities.  Challenging to provide consistent social prescribing service in remote and rural areas, there is poor access to public transport, poor broadband coverage, lack of capacity.   Rural and remote areas may not have enough people with similar issues to create a social prescribing activity, this has implications for fundability and continuity.  COVID19 had a big impact on volunteering, often volunteers are retired people who had more risks at this time.   Challenges: health service culture, patients and professionals do not know enough about social prescribing, referral pathways which are variable and complex, community link workers are employed in different ways, severity of people's needs, health inequalities are entrenched, funding structure, difficult to maintain continuity. Great potential for many benefits of social prescribing.  Prescribing heritage based interventions through rural museums - drew attention to the need for co-productions in rural contexts and that projects need to be adapted to them. Danger of widening health inequalities if something is provided in one place but other surrounding communities don't have any activities.  Person centered approach works very well.  Link workers can help connect the primary care system with social prescribing activities.  Clear referral pathways are needed.  Sustainable and longer term funding is important to help make social prescribing successful.  Funding, recognition and support are vital for sustainable social prescribing.  The third sector recognises that there is a great need for social prescribing, more so after the pandemic.     Contact: [email protected]  Wales School for Social Prescribing Research  Home (wsspr.wales)  Scottish Social Prescribing Network -  SSPN – Scottish Social Prescribing Network (scottishspn.org.uk) Voluntary Health Scotland - Scottish Community Link Worker Network - Scottish Community Link Worker Network (vhscotland.org.uk)