Of all the stories that I wrote this year, here is an edited version of the one that I most enjoyed doing – about a small rural community in Victoria that is taking small but great strides to improve the health and wellbeing of its members.
The full version appeared in Australian Rural Doctor, and all credit to the editor, Marge Overs, who heard about it at a rural health conference, and saw its potential for a feature. I don’t know many editors who would put a story like this on the cover…
From small steps, big things grow
Dereel, a blip on the road between Ballarat and Colac in the Western District of Victoria, hasn’t much to skite about. The post office closed in 1971, its solitary shop recently shut down, for the third time in as many years, and there isn’t even a pub.
The several hundred people who live on small rural blocks scattered around the area are used to either travelling for services, or doing without. It is no big surprise that official statistics show their health is not the best.
But in the past few years, a new sense of community has begun to emerge which is bringing health and social benefits, and sometimes in quite unexpected ways.
The community hall – Dereel’s one focal point – now often rings with the sound of activity, whether it is blokes cooking up a storm in the kitchen, or women nattering over a cuppa after their morning excursion with the walking group.
The walking group has been a powerful health boost for the local community, way beyond the merits of regular exercise. It has been instrumental to the success of Bennita Hough, a community nurse whose work has helped revitalise Dereel over the past three years.
When Mrs Hough was appointed to run a part-time community health clinic, a joint initiative of the local council and area health service, she knew that simply announcing her doors were open wouldn’t cut the mustard. The locals, especially those most likely to need help, were unlikely to show.
Instead, she took her clinic to the great outdoors. Twice a week, she joins up to a dozen women while they walk and talk. As the sounds of laughter and conversation spill along country roads, Mrs Hough listens carefully for the undercurrents, both for what’s not being said as well as what is.
“My way of doing it is to walk with the person who I can see needs to talk, and everybody else moves away,” says Mrs Hough. “I try and walk with everybody within the group at some stage.”
Health matters, particularly mental health issues, are a recurring theme.
It was on the morning walks that Mrs Hough realised some women would benefit from seeing a domestic violence worker; she arranged for one to visit the hall each month.
It was also on the morning rambles that Mrs Hough realised that some women were concerned about their husbands, wondering if they were depressed.
“We discovered that many of the men are lonely,” she says. “They work in their garden or shed. Many are retired and, apart from the fire brigade, there was nothing for them to do.”
Mrs Hough organised for a doctor to talk to the women about identifying depression in men. One thing led to another, and about a year ago, the first men’s kitchen kicked off, which Mrs Hough says has been a “brilliant” health intervention.
Between four and ten retirees, all with chronic diseases, attend the fortnightly session, where they chat and cook, before sitting down to a meal together – all for the cost of a gold coin donation.
Health is discussed but as part of the broader conversation. “We talk politics, religion, football,” says Mrs Hough. “The only thing off bounds is that I will not have dirty jokes and swearing. I say this is not Ramsay’s kitchen, and they will respond very well.”
However, the kitchen produces far more than tips on healthy eating or diabetes control.
“It’s all about being in a community, reducing their isolation,” says Mrs Hough. “It gets men together with men who they wouldn’t normally meet. Now some of them have gone fishing together. Some have joined the committee of management for the community centre.”
Networks developed through the kitchen have also had direct health benefits. When one of the men had a mini-stroke, he wasn’t taking any notice of his wife’s suggestion to see a doctor – until she called in Mrs Hough. “She came to our house; if she hadn’t of done that, I would have argued with my wife that I was alright and I wasn’t going to go to any doctors or hospitals,” the man said.
Mrs Hough’s community building work has its origins in a series of tragedies that hit the Golden Plains shire, which lies between Geelong and Ballarat, several years ago.
After a number of suicides, the shire embarked upon a mission to develop some innovative strategies to cope with the high level of unmet health and social need in the area. With about 18,000 people dispersed over thirty five of small settlements, the shire is an area of high population growth, and has a concentration of young families and retirees. It has few services on offer, having no major regional centres within its boundaries.
In 2003, the shire published a rural health strategic services plan, which observed that the lack of services was magnified by the dearth of social capital in the area, with many people living in isolation.
It recommended the shire develop strategies and services based upon a social model of health, taking “account of the full range of societal, economic, environmental and biomedical factors that influence people’s health and well-being”.
“The model recognises the role played by individuals, families and communities, together with professional services, in achieving improved community health and well-being,” stated the plan.
It is a model that Jaclyn Reriti, a health promotion professional, has been implementing since being appointed Shire’s Health and Wellbeing Coordinator two years ago. She says the Shire decided to take the lead in driving health improvements in the area, because of the lack of other service providers, and has worked hard at setting up partnerships with health services and government departments in Geelong and Ballarat.
Through these partnerships, the shire has won funding from the Victorian Department of Human Services to establish The Golden Plains Health andWellbeing Program which has lead to a series of community health projects, including the Community Health Nursing at Dereel and a Golden Plains Health Planning Forum.
“The health planning forum meets three times a year in the shire and involves all the managers and decision makers from key health services and government departments in Geelong and Ballarat, including the divisions of general practice,” she says. “The program also offers community group support through the Gem of an Idea (Health & Wellbeing) Grants.
“Bennita is part of the Health and Wellbeing Team through Ballarat District Nursing and Healthcare, and the success of the work that has been achieved has been strongly, supported and managed through the partnership with the Shire and District Nursing through the Health and Wellbeing Team.”
Progress has not always been easy or straightforward, adds Ms Reriti, as gaining an understanding of what communities really want can be difficult. Simply providing services does not mean they will be used, she adds.
Ms Reriti says that building social networks is important, not only for a community’s cohesion and health, but also for helping to ensure services are appropriate to local needs.
“You cannot get people in through sending out brochures,” she says. “We take a strong community development approach to our work as we need to find a way to get people in; otherwise you cannot share information or know the best way to share the information, you cannot find out what their issues are in an informal way, and you cannot let them know there’s a service.”
For Dr Alexander Murray, who has been a GP in Ballarat for 37 years, any initiatives to build community health resources are welcome, especially given the “desperate” shortage of GPs locally. “Community health centre work is extremely important, not only for health but also for communication,” he says.
“Older men especially are very reluctant to go looking for doctors until they’re sick. I think the rural nurses are going to play bigger and bigger roles because they can communicate so well with the patients.”
I’ve deleted much of the detail from this version of the story for privacy reasons. Suffice to say that the stories of some of the locals really had an impact on me – people who had suffered terribly during their lives, from domestic violence, poverty and other hardships. Many had not previously come into contact with services or had the opportunity to tell their stories.
What I like about the story included:
• It’s a reminder that simply providing services to under-served and disadvantaged communities isn’t enough. The people need to be engaged from the outset, in identifying what services they need and will use.
• That health is about far more than health services, and that many other sectors can contribute to improving the community’s health.
• The importance of relationships for health, both within communities and between the community and health care professionals.
• The remarkable resilience of humanity.
And on that note, I wish all Croakey readers and contributors a peaceful and safe festive season, and a healthy New Year!
Croakey will return around January 4.