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Rugged makes ready

Educator says the harsh life in remote Australia is the perfect breeding ground for nurses and midwives. 

Nothing makes a better nurse than growing up in the bush, Jane Mills tells her audience.

Mills, an associate professor from James Cook University, says nursing students who are rural Australians are being prepared for life after graduation in unique ways that will give them an advantage over their city-dwelling counterparts.

“A bush education produces traits like resilience, resourcefulness and perseverance,” she says.

As part of the annual series of Rob College lecture-dinners held by the University of New England, Mills told of her experiences growing up in the bush. She spoke of the typical trials that people raised in rural or remote areas face that can foster practical skills. There is one term, in her option, that encapsulates many of the creative strategies and solutions people from the bush must come up with all the time – ingenious.

“In my experience, just keeping the power and water operational can be an exercise in resourcefulness in the bush,” she says. “Necessity really is the mother of invention, and the skills you learn when you have to improvise or come up with a workable Plan B are readily transferable into the workplace.”

She says this ingenuity often comes from the need to be independent and autonomous. “Many things need doing in the country but there are rarely many people around to do them. So you get on with the job. And you keep on with the job until it is done.”

Mills says the monotonous jobs that rural children do train them well. “You develop perseverance − a trait that is often the difference between success and failure.” She says this differs from the city, as everything is at hand or can be easily bought or outsourced.

In the country, risks are high and important jobs upon which livelihoods and families depend can come down to one person, and that person must step up. “High stakes risk analysis is commonplace; the ability to make decisions and the guts to take responsibility for those decisions are a necessary part of rural living,” she says. “Bush dwellers cannot be risk averse, which promotes resilience because things do not always go right and you must keep going, even when things are all wrong.”

Growing up in the country, a potential nurse learns how to have a strong sense of identity and connection with others, Mills adds. “You understand the importance of empathy, of patiently listening to others. This understanding of community comes from growing up in a much smaller and interconnected group of people.”

Australia’s chief nurse, Dr Rosemary Bryant, agrees with Mills’ view that resilience comes from life in the bush and has worth in nursing and midwifery.

“Like the patients they are treating, health professionals working in rural or remote areas experience a unique set of challenges,” Bryant says. And Mills emphasises that with the divide between country and city still causing concern, future health professionals have the power to improve the bush by simply being there.

“By [working] for a life, a time, or even a short stint in rural and regional areas, health professionals can help build strong, healthy communities in the towns where they work and the professional health communities to which they belong,” she explains.

She also points out that research shows people who have grown up in rural and remote Australia are much more likely to return to the bush to live and work later in life.

That’s exactly what Mills did.

Mills’ family didn’t have the funds for university. Her father lined up an interview for her at the Royal Hobart Hospital to train as a nurse.

“I loved being a nurse,” Mills says. “Within a short space of time, I couldn’t imagine being anything else.”

Once registered, Mills flew to London for a year before returning home to the bush to work as a nurse in a remote area on the west coast of Tasmania.

Mills says attracting the next generation of health professionals and inspiring them to return to the bush is the only solution for tackling the healthcare problems faced there.

“Using a standard measure of deaths per 1000 population, the further you live from … a major city, the greater the chance you have of dying this year,” she says.

The Australian Institute of Health and Welfare holds that the main contributors to higher death rates in regional and remote areas are coronary heart disease, other circulatory diseases, motor vehicle accidents and chronic obstructive pulmonary disease. Bryant confirms that in comparison with metropolitan areas, rural and remote Australians generally experience higher rates of death, morbidity and chronic disease, have a shorter life expectancy, face higher health risk factors, have higher rates of preventable cancers such as melanoma and lung cancer, and have lower levels of health literacy.

She adds the remote and rural populations are older on average, a greater proportion lives with a disability, and people experience harsher environmental conditions and relative social isolation. They also have difficulty sourcing fresh food.

Mills says the smoking, obesity and heart, stroke and vascular disease rates are all much higher in regional and remote areas than in major cities. “Coronary heart disease accounts for the highest number of deaths in Australia, with 11,733 men and 9780 women succumbing to this condition in 2011,” she says, adding the contributing factors to acquiring and dying from cardiovascular disease are much more prevalent outside of a major city.

The picture is even more bleak for Indigenous people. Whilst the average rate of psychological distress is 10.8 per cent for all Australians, it jumps to 30.1 per cent for Indigenous Australians.

“Overall, Indigenous Australians have higher rates of smoking, heart disease, stroke, vascular disease and diabetes compared with the total Australian population,” Mills says. “This is particularly so in regional and remote areas.”

Mills used data drawn mainly from the census to illustrate the distribution of healthcare professionals. She wanted to show an up-to-date picture of who is providing healthcare services in rural and remote areas.

“Nurses are by far the largest health workforce group in Australia, with fairly consistent numbers per 100,000 population, regardless of location,” Mills says. “The same can’t be said however for other health professionals, with people living in major cities having far greater access to clinicians providing both tertiary and primary healthcare services than those living in regional, let alone remote, areas of Australia.

“A lack of access to primary healthcare services in areas with geographically dispersed populations affects the overall health and wellbeing of the populations living in those areas. One of the greatest challenges in our country is cost-effective delivery of models of healthcare that will ensure equitable access to health services close to where we live.”

To address this, Bryant says, more investment in regional universities is needed, with the aim of building a local workforce across the full range of disciplines.

“This investment must also include the all-important transition-to-practice phase in a new health professional’s working life, which, to date, has been both underdeveloped and under-researched,” she explains.

Bryant adds that Australians must continue to honour the unique healthcare needs of regional, rural and remote populations, particularly those of Indigenous people.

“We can do so as health professionals or policymakers,” she says, “by redefining models of primary healthcare, designing a new health service, delivering and undertaking education and training, and providing excellence in clinical care.”

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