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​Bushfires continue and the essential role of GPs in supporting their communities
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This week, it has been heartening to learn about the contribution of general practitioners during the Australian bushfire crisis. A number of GPs have contacted me to share their experiences. The recent RACGP article on the role of GPs in Merimbula is a great example of GPs coordinating the health care needs of their fire affected community. https://www1.racgp.org.au/newsgp/professional/paper-cups-for-spacers-oxygen-from-dive-shops-how
I have also heard first-hand about the challenges GPs have experienced in providing essential primary care in partnership with state and federal agencies. It is evident there are lessons to be learnt. Conversations and planning is needed now to ensure, state and federal agencies immediately collaborate with general practitioners.
Along with my colleagues, I am advocating for greater recognition of the role of GPs during an emergency crisis. General practitioners have the required expertise and need to be part of future disaster planning at a state and commonwealth level.
For bushfire affected communities, GPs are central to community rebuilding. General practitioners will be there to support individuals and families as they assess their situation and begin the task of rebuilding their homes, lives and incomes. Patients in these communities will want timely access to GPs. They will expect continuity of care and coordinated support from their GP as they engage with multiple agencies to rebuild their lives. General practitioners are ready for this work.
The two new Bushfire Recovery Agencies, one at a Commonwealth level to be led by Mr Andrew Colvin, and one in Victoria to be chaired by Mr Ken Lay have important work to do. Their work will benefit from engaging now with rural general practitioners working on the ground with fire affected communities. I recommend these agencies appoint a general practitioner to work alongside the leadership. The role of the GP would be to inform appropriate consultation, ensure genuine community responses and smart investments that benefit the long term health needs of communities impacted by bushfires.
As the threats from Australian bushfires continue, I extend my thanks to GPs in these communities for their work and I hope they continue to be safe.

​​​As we continue to watch the bushfire crisis unfold, I am in awe at the impressive, selfless community effort of people across Australia. Every hour we learn more about the role of communities, firefighters, emergency service personnel, our defence force and public officials who are working around the clock to respond to these fires. I am thinking of all of you at this difficult time.
In many areas, fires have been impacting communities for several months. In other towns, the threat of fires is new. The community spirit of support, volunteerism and teamwork is evident to everyone. At this time, there is a sense of solidarity, of looking after each other and of not leaving anyone behind.
There are many general practitioners who live in communities that have been affected by fires. I have been thinking of these GPs, their teams and their families. I have heard stories of GPs providing quality health care during the crisis. I know these GPs will continue to support their communities, after the crisis has passed. However, I have also heard from GPs of their admiration for the role of community members in looking out for each other and in coordinating a community response. At this time, general practitioners are just one of many, working together, to support communities who are faced with unimaginable devastation or the ongoing threat of fire.
My thoughts and prayers are for all involved. Take care and be safe and always reach out for support if you need it.
​Ayman Shenouda

​The health effects of drought and our role in planning
 
Dr Ayman Shenouda
 
Last week’s blog on GP-led strategies to reach out to drought-affected farmers has started some good discussion around the role of GPs and our broader public health role.
 
What we are seeing is a significant drought particularly in the worst-affected parts of NSW where the current dry conditions have spread to most inland parts of the state.
 
The recent media focus is a good thing to keep some philanthropic and government dollars flowing, but we really need a better preventative strategy to protect our farmers and our food resources from these extremes.
 
What we are seeing is reactive policy which only demonstrates the ineffectiveness of our national drought management policies.
 
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.
 
In helping our communities prepare for drought, GPs should have a leading public health role in developing drought-related public health vulnerability assessments.
 
This involves working with the community and key partners to ensure coordinated preparedness and response efforts. Staying engaged through non-drought periods is essential.
 
Here are some key steps that we could consider in undertaking drought planning and vulnerability assessments in our own communities.
 
Step 1
Identify vulnerable populations
 
It is clear that drought severity and the vulnerability of particular populations requires a more targeted and planned response.
 
While the health effects of drought can be severe, the health disparities in diverse rural communities can make public health planning a challenge.
 
This is why GPs need to have an active role in identifying those priority groups within our community.
 
Most rural practices sustain themselves by being attentive to key changes within their communities and know how to work within constrained resources.
 
We need to allocate a greater proportion of total health resources to drought impact mitigation and prevention.
 
A key part of this is enabling planning and establishing a leadership role for GPs in decisions to develop appropriate models of health care for these at-risk groups.
 
It is important to note that there is also a doctor drought in some regions too.
 
The distribution of GPs to underserved areas requires similar planning together with ensuring the adequacy of health infrastructure for longer-term service viability.
 
Step 2
Make disease projections
 
We need more data around this but generally, populations face an increased risk of illness in the year they are exposed to drought.
 
A formal role for GPs in addressing the data gaps to build more evidence around the causal links between health and the environment is needed to inform future policy nationally.
 
More research dollars and faster research into what works at the local level to help us better understand the risks and health status of populations.
 
This requires a sustained research effort and is part of a broader investment strategy and structured support towards disease prevention.
 
Step 3
Planning for specific health effects
 
Droughts have many consequences for health. Social impacts are quite obvious as drought contributes to debt burden and the psychological impacts run deep.
 
Generally, we will see more air and water-borne diseases and infections, with effects on air quality including related respiratory illness.
 
The worsening of chronic illnesses and mental health conditions through social impacts and compromised food and nutrition.
 
The more immediate impacts of heat include increased risk of dehydration and heat stress.
 
A community capacity-building program for drought response should be prioritised to both assess drought impacts and explore actions in response from a health perspective.
 
We have a good understanding of what the health vulnerabilities are for our own communities in times of drought. Allocation of funds towards drought mitigation in relation to health is needed.
 
Step 4
Establish intervention strategies
 
Inadequate social impact indicators make this task harder but we need to think about building resilience to drought.
 
In building resilience, implementing critical programs to protect the most vulnerable health populations in specific locations is important.
 
Building the evidence base for population-level interventions will also help close the gap between research and practice.
 
A national program to support communities to undertake drought-related public health vulnerability assessments is a good way to make this happen.
 
GPs should have a leading role in supporting proactive mitigation and health planning measures in managing drought risk and health impacts for their communities.

Healing in times of drought: GP-led strategies to reach out to drought-affected farmers

Dr Ayman Shenouda

Those living in rural Australia don’t need to see a politician donning an Akubra to confirm just how bad this drought is.
Rural communities know only too well what this almost constant climate of suffering looks like. How this hardship can impact on community morale and health and particularly for mental health.
 
This is clearly seen at the practice level in our patients with notable increases in the rates of depression and anxiety and with more and more patients disclosing suicidal thoughts.
 
The most devastating reality of drought is of course suicide which is in part a system failure and a shift in placing prevention at its heart will require a very different model to the one we have.
 
Only this week a patient came to me and described just how close he had come to suicide:
 
‘I came very close this time. Opening my shed looking at the rifle - it was very tempting to finish it all.’
 
This was a farmer reaching out for support and with this key step, the healing journey can begin.
 
The depression begins with a downturn in cash flow and in a multi-year drought, there is often no clear way forward for them.
 
A key hurdle for us is in reaching out to those more adept at hiding the problem. Trust is a big part of it.
 
In rural people, particularly men, this is sometimes very well hidden. They often try and hide the problem and all too often we find it is too late to help.
 
We are missing a lot of patients – those who won’t come forward – and this is where our funding dollars are most needed right now.
 
It is often the case that even when mental health services do exist within a community, farmers are unlikely to utilise these services.
 
A solution is for the GP to get out to the community and this is precisely what we’ve been doing in Wagga and The Rock Communities
It involves taking your practice to the patient and there’s currently no real funding tied to this. This effort relies on the goodwill of the GPs, nurses, other clinicians and allied health professionals.
These are ground-up initiatives to help communities manage their health and mental health. And these are the strategies that we know work in rural communities.
I’d like to share a couple of practical strategies we’ve undertaken to reach out to those harder to reach farming patients.

The Pub Patient information nights
The pub is a good place to start. We often do talks in the pub which will have a formal health topic for the evening inviting the community to join us in the discussion.
 
We see two groups form here. The ones actively involved in the discussion and those sitting at the bar (but listening). It is the latter that is often the most critical to reach.
 
But it can start the conversation and importantly their involvement in their own health and wellbeing as well as new strategies to cope.
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Field day pitstop
The field day pitstop check-up clinic places us right in the thick of the action. This is where farmers gather to exchange ideas, trade their goods and importantly just get together.
 
We usually set up a tent clinic with a couple of doctors and practice nurses providing health and lifestyle assessments.
 
We cover emotional wellbeing and general health checks looking at BMI, blood pressure, respiratory testing, blood glucose and covering other risk factors including cholesterol screening.
 
These tests are vital and will often get them into your clinic and under your care longer term.
 
Sparking that vital conversation around mental health is a key objective here and we aim to provide links to rural helplines and connect through to outreach initiatives.