Healing in times of drought

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.