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Mayara Floss: the challenges for women working in rural health

Mayara Floss

This video of Dr Mayara Floss – rural doctor in Brazil and passionate advocate for international rural health – has recently been publicised via the Rural WONCA email list by Dr John Wynn Jones, chair of the WONCA Working Party on Rural Health.

Mayara was invited to give her perspective on the issue of “Investing in rural health workers for the economic participation and empowerment of rural women and girls” at a meeting of the joint Commission on the Status of Women: a side-event of the World Health Organisation, International Labour Organisation, Permanent Mission of Ireland to the United Nations and Women in Global Health.

John introduced the video more eloquently than I could, and so with his permission, here’s what he said:

Dear All

I want to congratulate Mayara and thank her on behalf of Rural Wonca and all the rural health workers around the world for her presentation and wise words at the United Nations Commission on the Status of Women. Mayara is an exceptional person. I can’t even call her a future leader because despite the fact that this is her first year as a doctor she is already a world leader and an example to us all. It will be the Mayara’s of this world who will take up the mantle for the next generation and its our duty to support them.

Please look at the video of her session. She describes how medical schools in the largely rural country of Brazil do little to promote and teach rural health care. She eloquently describes her own journey against the odds and her quest to work among rural communities and the barriers that she encountered. Everyone needs to watch her presentation! 

During the panel session she implores us first to listen to our patients and are communities before coming up with ” so called helpfull solutions”.

She also asks us to think about the political tragedy that is happening in Brazil and the dismantling of one of the most enlightened primary care systems in the world and its replacement with private health.

We are all very proud of her and the many other members of Rural Seeds who are working so hard around the world to build their careers and make a difference for rural communities.

Kind regards

John

Mayara speaks in the video below for 20 minutes, at 30 minutes in, and there are subsequent (excellent!) contributions to the discussion thereafter.

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Call for new Rural WONCA Committee Members

Rural Wonca is calling for nominees for the Rural WONCA (Working Party on Rural Practice) Council 2018.  

Council is meeting at the 15th Wonca World Rural Health Conference in New Delhi in April.

Rural Wonca is this year seeking especially candidates from the following categories:

  • Young doctors
  • Female
  • Developing countries
  • Student
  • Indigenous

Other existing criteria include that would be considered favourably include:

  • Underrepresented region
  • Underrepresented country
  • World recognised authority
  • Nationally recognised
  • Practicing rural doctor

All candidates will be considered. Rural Nurses and other health professionals will be considered.  The positions are not representative of any organisation.

It is expected that successful candidates will bring to Council a passion for rural practice and rural communities.

The closing date for applications will be  COB UTC 16th March 2018.

The candidates will need to:

  • Submit a completed application (attached) +/- CV and
  • Submit a video (no more than 5 minutes) outlining why they should be considered for Council. ( A google drive link will be provided on receipt of application).

Please submit applications to

Bruce Chater – email bruce.chater [at] theodoremedical.com.au

Rural Wonca look forward to hearing from you.

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Prof Paul Worley – Rural Health Commissioner for Australia

In a really interesting development for rural health internationally, Australia has appointed its first Rural Health Commissioner.

Charged with the responsibility of overseeing and driving a wide range of activities around supporting ‘rural generalism’ the post offers a chance to provide more co-ordinated leadership across domains, regions and disciplines to make rural health strategy more cohesive in Australia.

Professor Paul Worley has been appointed as the first Rural Health Commissioner and this move has been widely welcomed across the rural health community.  He brings an impressive portfolio of experience to the post, including in clinical, academic, educational and strategic development aspects of rural health.  You can watch Dr David Gillespie MP announce the post, and Prof Worley outline some of his visions for the future (at 5min 55s), in the video below.

Twitter and other social networks – including the WONCA Working Party on Rural Health international email list – have been buzzing with positivity about the new post, and it is likely that this approach might pave the way for similar developments in other countries.

In Scotland, we are watching developments with interest.  Rural medicine and health services are of significant importance in Scotland’s National Health Service – 98% of Scotland’s land mass is rural, and 18% of Scotland’s population live in a rural area, with many more flocking to rural areas during holidays.  And yet despite considerable aspects of medical care being delivered by GPs and primary care teams, within community hospitals, A&E units and facilities outwith the usual remit of GPs, there continues to be relatively little in the way of co-ordinated clinical governance and strategic unity to link rural and isolated practitioners together.  These services provided by rural GPs remain considered to be on the ‘fringes’ of general medical practice.  Therefore the opportunities created by appointing an experienced individual to provide leadership, stimulate innovation and inspire positive approaches, are sorely needed in areas other than Australia.

Having met Paul at the WONCA World Rural Health conference in Cairns this year, I’m delighted to hear this news and inspired to think that this is a situation to watch closely.  I have little doubt that we will be reflecting that Scotland could benefit from a similar approach in the near future.

Well done Australia, and all the folks involved in making this happen.  These are exciting times.

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RRH Guide to Getting your work Published

One of the sessions at #ruralwonca was delivered by some of the team at the Journal for Remote & Rural Health.  I was really sorry to miss it, due to presenting in another session, but my tweeted request to make the advice available online was answered quickly and the presentation is now available – see below.

The journal team are keen to encourage and motivate rural healthcare professionals to share their research, and seem genuinely interested in helping budding writers to put pen-to-paper or finger-to-keyboard.

There is a lot of great innovation and problem-solving going on in rural practice.  Rural healthcare professionals tend to know their communities well, are used to dealing with limited resources, and some of the best examples of teamwork are to be found in rural settings.  However ‘being academic does not come easy to everyone, and the process of writing up evaluation and research can sometimes feel tedious and time-consuming.

However, it is now easier than ever to find interested journals, and there seems to be a drive to make the steps to getting work published more accessible.

Watch the presentation below for the RRH team’s top tips on getting your research out to a wider audience.  You can find the guidelines for authors available here.

Also, on the theme of research, here’s a great project that aims to enable rural doctors to develop their research activity through pragmatic and direct support.  Delivered by the Faculty of Medicine at Memorial University in Newfoundland, it’s called the ‘6 for 6’ programme.  Click here for more details or watch the video below.

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AProf Bruce Chater on Dr MacLeod and #ruralwonca

Today RuralGP.com highlighted the tribute speech given by Associate Prof Bruce Chater to the life and work of Dr John MacLeod of Lochmaddy in Scotland.

I was delighted to catch up with Prof Chater after his speech, to ask him more about Dr MacLeod’s work with Rural WONCA, how the WONCA Working Party for Rural Practice is progressing, and also for some advice to younger rural doctors on how to effect change in their own communities.

You can listen to the recording below…

 

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The legend of Dr John MacLeod remembered at #ruralwonca

Today’s #ruralwonca programme includes a keynote delivered by Associate Professor Bruce Chater: the Dr John MacLeod Oration.

Dr MacLeod was a legend in the world of WONCA and an inspirational rural GP.  I regret that I never had the opportunity to meet him; my own career in rural practice was just starting when he died and whilst a student experience in the Hebrides (Stornoway) was an inspiring part of my own interest in rural practice,  my travels didn’t take me to Lochmaddy.  I was running the RuralGP.com site at the time of his death, however, and you can read more about Dr MacLeod in the obituary, eulogy and tribute that were published at the time by Dr James Douglas and Dr John Wynn-Jones.

His legacy in the WONCA World Working Party on Rural Practice is evident, and I’m looking forward to hearing more from Prof Chater’s perspective in his keynote today.

Dr Sarah Chalmers

In the last few days I also met Sarah Chalmers.  When Sarah was a medical student, she experienced an elective with Dr MacLeod and I was delighted to be able to ask her more about her experience in this podcast.  Coincidentally, she had arranged another elective which had fallen through, and it was a chance conversation at a student event with Prof Chater which led to him emailing Dr MacLeod and thus the elective was set up in Lochmaddy instead!

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Protective personality traits for LICs

Assoc Professor Diann Eley

Today I attended a session at #ruralwonca which was delivered by Associate Professor Diann Eley from the University of Queensland on the role of personality traits on student experience of Longitudinal Integrated Clerkships.

Diann has gained considerable experience in this area, and specifically on how best to support and mentor students effectively whilst encouraging them to reflect on their own personalities – and how that impacts on their clinical decision-making.

I was delighted that Diann gave me a few minutes of her time after her presentation to discuss this in more detail, particularly as this work is highly relevant to the development of LICs in Scotland.

You can listen to our discussion here:

 

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A word with the Auzzies at #ruralwonca

At lunchtime today I was delighted to catch up with Australian rural doctors John Hall, Aaron Sparshott and Katie Chang.  I asked them about their experience of the conference, their current careers and a bit about the success of the Australian Rural Generalist Pathway.

 

John, Aaron, Katie around a typically chilled-out kangaroo that we found in the exhibition hall.

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Clinical courage: an evolving concept crucial to rural practice

I was introduced to the concept of clinical courage when attending an International Rural Research Symposium last year at Tromso University in Norway.  Dr Lucie Walters, of Flinders University in Australia, ran an enthralling workshop about some work that she and her team are doing to quantify and understand what we mean and can learn from clinical courage, particularly in the context of professional isolation and delivery of rural health services.

It’s a concept that seems to resonate easily with rural health practitioners, particularly rural GPs.  Despite this, there is relatively little that I have found to expand on the concept.  Two very helpful resources are a “President’s Message. Clinical Courage” by Dr John Wooton (found in Can J Rural Med 2011; 16(2)) and two comments from Peter Dunlop and Keith MacLellan in the followup issue (found in Can J Rural Med 2011; 16(3)).  The latter comment introduces another concept of ‘learned helplessness’, and I suspect that this will be of increasing importance as debate evolves regarding the fragmentation of undergraduate curriculums and the need to consider generalist undifferentiated training versus teaching in more specialist settings.

So, I was delighted to be asked to participate in an interview run by two of the Flinders University students Ella and Laura who are assisting with the project, whilst here in Cairns at the WONCA World Rural Health Conference.  They interviewed me, and they kindly agreed to me interviewing them!

You can hear about their experiences of medical teaching so far, and also more about the concept of clinical courage in the audio clip below:

 

Ella and Laura, 2nd year medical students at Flinders University

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