How can GPs best help people in Australia’s drought-affected regions?

Doug Hendrie

23/08/2018 3:11:25 PM

Rural and remote GPs in NSW and Queensland are finding novel ways of reaching people badly affected by the record-breaking drought.

The big dry is taking its toll on the mental health of farmers and others in Australia’s drought-affected areas. (Image: David Mariuz)
The big dry is taking its toll on the mental health of farmers and others in Australia’s drought-affected areas. (Image: David Mariuz)

While Dr Claire Schmidt flies in to see patients on remote stations, her grazier husband tries to keep their cattle alive through the seventh year of drought.
Drought is always on the mind for Dr Schmidt, a GP and senior medical officer with the Royal Flying Doctor Service (RFDS) in Charleville, 750 km west of Brisbane.
When Dr Schmidt first came to Australia from the UK, she was struck by the stark beauty of the mulga country.
‘It’s incredible country and full of amazing, resilient, hardworking individuals, families and communities who know how to do it tough,’ she told newsGP.
‘They’re such a positive group of people – all the time. But I think we’re heading for that cliff edge. We’re running out of positivity, resilience, “It’ll be right this time”.
‘It’s been seven years of drought. It’s getting to a point where it’s just too much for people.
‘We’re seeing it first-hand at home, with our cattle property, and with our friends, as well as at work.’
Australia’s eastern states are wrestling with drought, with major rainfall deficiencies across NSW, south-west Queensland and northern Victoria. And GPs are on the frontline of helping farmers and townspeople deal with the impacts.
The challenge, according to Dr Schmidt, is finding the people who are really struggling before it’s too late. The spectre of suicide is ever present.
‘The overarching concern is this relentless uncertainty, the immense financial stress, the sense of failure,’ Dr Schmidt said. ‘People seek isolation when they’re stressed. They disconnect from the community.
‘We’re trying to help more people, but it’s really hard to have contact with them.’
That isolation means that GPs and other healthcare professionals have to be alert to possibilities, such as calling patients about getting a routine check-up, and then asking the real question: How are you coping?
The RFDS also runs field days, where they show graziers on large properties how to maintain their air strips and how to best launch flares if a plane full of medics has to land at night.
But these field days are also an excellent way to find people experiencing depression who might have gone to ground. 
‘There is an unmet need we’d desperately like to meet,’ Dr Schmidt said.
‘The nature of depression and suicidal thinking means that these people are cutting off friends, family and the community. Because their communication skills are affected so greatly, people stop asking if they’re okay, and that’s when you have the horrible spiral downwards.’
Farmers get most of the attention, but Dr Schmidt said small businesses in towns are also under considerable stress.
‘There’s no money to spend, so they go under,’ she said.
The RFDS has recently won four years of funding to run a drought and wellbeing service in Longreach, but that’s 500 km north-west of Charleville.
Another challenge for GPs in drought-affected areas is having to deal with their own emotions. As residents of these areas, healthcare professionals are not immune from the stresses that pervade the community.
‘There’s a huge emotional strain on doctors, it can be very draining. You have to be able to stand back a fraction in order to cope with it all’ Dr Schmidt said. ‘There’s so much [need], you can feel you’re not making headway.
The Federal Government this week announced a $13.7 million grant to national healthcare support organisation CRANAplus to boost training, support and professional services for rural and remote healthcare workers.
Drought is also on the minds of GPs further south, in NSW’s Wagga Wagga.
There, RACGP Rural Chair Dr Ayman Shenouda is a practice principal of Glenrock Country Practice, which has three clinics in and around the town.
A patient who came to see Dr Shenouda last week described how he’d found himself looking at his rifle every time he went into his shed.
‘I came very close this time,’ he told his GP. ‘It was very tempting to finish it all.’

Ayman-2-text.jpgRACGP Rural Chair Dr Ayman Shenouda and his practice teams in Wagga Wagga, NSW, are making efforts to address the issue of suicidal ideation among struggling farmers. 
Dr Shenouda told newsGP he knows of several farmers who had committed suicide. In an effort to tackle the issue, he and his team have run men’s health nights at the pub and opened pit stops at events like the Henty Machinery Field Days, where farmers congregate to buy new farming equipment.
‘We try to attract those farmers who are not going to their doctors, just to have a chat with them,’ Dr Shenouda said.
‘The problem is that, for farmers, admitting to depression feels like failure. It’s something that’s very difficult for them to do.
‘If they have an established relationship with their GP, if they have trust, they would come in. But others won’t, and that’s where it can be very risky.’
Dr Mary Ross is the practice principal of Trail Street Medical Centre, also in Wagga Wagga. She said the drought is greatly affecting her patients.
‘You see the hardships, the financial strain, the relationship pressures and, of course, the mental health aspect,’ she told newsGP.
‘Having the continuity of care is very important. Male farmers are often working singlehandedly in remote areas, and that means they are isolated both geographically and mentally.
‘There’s that stoicism you often find in male farmers, that masculinity that can lead to, “I’ll be right”.’
Dr Ross said GPs could best respond by being mindful of the situation in which their patients might already find themselves, and working towards looking after a patient long-term.
‘It’s often about being receptive and reading the signs that may be there, so you can have a conversation about their emotional health,’ she said.
It’s clear that the impact of drought is far reaching. But not everyone is affected equally.
A recent study found that the more isolated a farmer is, the more vulnerable they are to the stress of drought and the financial problems that often came with it. 
The Medical Journal of Australia study, led by University of Newcastle researcher Emma Austin, found stress is more acute among younger farmers.
‘General practitioners are in a unique position to contribute to programs and initiatives for relieving stress related to climate adversity and for supporting farmers experiencing stress,’ the authors write.
Dr Shenouda agrees. He believes it is time to shift from a reactive stance on drought to a preventive strategy.
‘We need to allocate a greater proportion of total health resources to drought impact mitigation and prevention,’ he said. ‘In helping our communities prepare for drought, GPs should have a leading public health role in developing drought-related public health vulnerability assessments.
‘While short-term drought-related health shocks can be more obvious, it is those longer term, more indirect health implications that are harder to measure and monitor.’

drought farmers mental health rural health

newsGP weekly poll Which of the below incentive amounts (paid annually) would be sufficient to encourage you to provide eight consultations and two care plans to a residential aged care patient per year?

newsGP weekly poll Which of the below incentive amounts (paid annually) would be sufficient to encourage you to provide eight consultations and two care plans to a residential aged care patient per year?



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John Harrison   24/08/2018 7:54:18 AM

Bulk billing and adequate time to talk things through in consultations is probably the basic assistance we can provide. Home visits would be a bonus but they take time and effort as do the patients, who in turn visit us. Their time in this situation is more valuable because they, the farmers and the communities, are in abject crisis.