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Stop bashing the bush

The pluses of working in rural areas have been pushed aside by those who concentrate on the negatives, writes Lisa Bourke.

Most people have heard about the challenges with rural and remote health but this constant focus avoids discussion of the many positives of working “out there”.

The focus on high workloads ignores the fact that some health professionals find rural practice very stimulating; the diversity of work, the autonomy of practitioners and relationship to the community can be very rewarding.

There is plenty of discussion about the lack of health practitioners (doctors, nurses and allied health staff), the difficulties patients have in accessing health services, and the appalling state of Aboriginal and Torres Strait Islander health.

In fact, both rural and remote health have become almost synonymous with “problems”.

Promoting the problems in rural and remote health has been used to attract funding in order to address them. But the continual promotion of problems over and over again has taught the public that rural health is itself problematic. The focus on rural health as problematic undermines all retention efforts; if it is problematic, why would anyone want to work in rural or remote health?

Addressing this myth, that rural and remote health are problematic, is key to attracting new nurses, allied health professionals and doctors to rural practice. And this is necessary for the sustainability of rural and remote health services as well as the health and wellbeing of rural and remote Australians.

This dominant belief, that rural and remote health are problematic, is a simplistic understanding of what is going on in these areas of Australia. For example, the focus on lack of doctors and recruiting a rural medical workforce denies the need for more rural nurses, who keep hospitals and clinics operational and provide much rural healthcare.

The lack of resources and staff can mean that staff are well utilised and use their initiative to address patient needs in innovative ways. There are rural practitioners who choose to work in rural and remote health and who would not work anywhere else.

Some practitioners love the diversity, the connection with community and to be able to observe the outcomes of their own practice in these environments. But generally, in discussions of rural and remote health, we hear little about such perspectives.

Embedded in the perspective that rural and remote health are problematic is an implication that they are lesser or inferior to urban health. This is based on an ideology that urban health is the “usual” and what everything is compared to.

But urban models of care do not work in rural and remote communities, and evidence about what actually works in rural and remote is lacking. Challenging urban ideologies that assume urban models of care, urban evidence and an urban workforce will “fix” rural and remote health is essential.

But urban ideologies extend beyond health. There is a powerful discourse running through political, social and economic circles that rural is lesser – rural is “behind the times”, culturally lacking and stagnate compared with progressive, dynamic and global metropolitan centres. This assumption, that rural is the lesser to urban, denies that rural and remote Australia house a range of cultural groups and the majority of Australia’s Aboriginal and Torres Strait Islander people and cultural heritage.

It further denies that Australia’s rural and remote economies contribute to feeding a nation, its economy and national exports. It ignores the fact that some Australians prefer to live in rural and remote places. Rural and remote are interwoven, interdependent and share a history with urban Australia. Yet myths about rural life pervade descriptions of rural and remote Australia and dissuade others from choosing to live and work these areas. Challenge to these stereotypes and stigmas of rural and remote living is long overdue.

Rural and remote are important aspects of Australia historically, culturally and economically.

Providing healthcare across this diverse and distant landscape is certainly challenging. But rather than view rural and remote as backward, and rural and remote health as “too difficult”, they can be understood as much more.

Moving beyond rural and remote health as problematic allows an understanding of rural and remote health as diverse and varied in different rural and remote communities. A realistic perspective identifies the capabilities of individuals and teams who have used limited resources to provide interdisciplinary healthcare in innovative ways.

An assessment of what happens “out there” presents new models of care that are patient-centred, community driven and integrated with staff needs. Moving beyond rural and remote health as problematic demonstrates that rural and remote health can contribute to how we provide healthcare in other contexts. When rural and remote health are not forgotten, they have much to offer (as well as to learn from) other areas of health.

Lisa Bourke is an associate professor with the rural health centre at the University of Melbourne.

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