Tuesday, 7 April 2009

Rural health care needs more support and incentives to make it a more attractive career option for health care graduates, according to a final year Podiatry student.

Heidi Chin said a limited number of podiatrists were struggling to service various towns with large numbers of patients. This had ramifications for the podiatrists and the patients.

“A great number of patients requiring urgent care experience difficulty in obtaining appointments,” she said. “This has disastrous implications, not only for the health system, but especially for high risk diabetic or renal disease patients who have diabetes or renal disease, where small wounds may result in serious ulcers, infections or amputations.”

Professor Alan Bryant, Head of Podiatric Medicine, said there was a significant shortage of podiatrists around Australia, largely due to the demand for podiatry services outstripping the supply of university graduates. It was particularly apparent in rural and regional areas.

“The situation is considerably worse with respect to remote areas of WA where the prevalence of diabetes related foot problems is high and the provision of podiatry services remains low and, in many areas, non-existent,” he said.

“I understand that the WA Health Department and the few private practices in larger rural centres have considerable difficulty in attracting and retaining podiatrists.

“To help address this problem, our final year students are being encouraged to undertake an optional two to four week rural placement in the hope that this may lead to a few graduates eventually practising in the country rather than in the Perth metropolitan area.”

Ms Chin said she would definitely consider rural practice on completion of her Bachelor of Podiatric Medicine degree. She recently completed a rural clinical placement with the Avon and Central primary health service, based in Northam, the major inland town of the Avon valley.

“It provided insight into working in a rural community and was extremely rewarding in terms of gaining invaluable personal, professional and clinical skills,” she said.

The placement involved treating patients at Northam regional hospital and in the neighbouring towns of Quairading, Narrogin, Merredin and Goomalling hospitals.

“In a rural setting with an ageing population, the Falls-Clinic ‘Stay on your Feet’ program is an especially important one,” Ms Chin said. “Falls for people aged over 65 years cost the health system $83 million in 2001–02, about 1.5 per cent of the total health expenditure in WA, and are a serious health issue affecting the mobility and independence of the individual.

“I was fortunate to accompany podiatrists who assessed, diagnosed and treated conditions ranging from dermatological conditions to biomechanical and systemic disease.

“GPs, nurses, occupational therapists, dieticians and physiotherapists were also involved, emphasising the importance of team management skills in the prevention of falls in the elderly.”

The podiatrists involved in the Falls-Clinic were also required for custom footwear advice. Physical conditions such as loss in muscle strength, poor flexibility at the hip, and loss of strength in the upper body and back, leading to gait changes, were addressed.

Ms Chin later spent time at the Aboriginal health clinic, where she treated many patients of various cultural backgrounds, encountering literary problems and linguistic barriers.

“This challenged me professionally, forcing me to employ other strategies to ensure communication was effective in order to maximise certainty in diagnosis, appropriate therapy and patient compliance,” she said.

“I also gained an understanding of the importance of Aboriginal health workers, who provide a link between the Aboriginal community and mainstream health services.”

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