Rural Round-up - September 13

Dr Jo Scott- Jones (pictured) is a rural GP from Opotiki, in the North Island of New Zealand. He is the public relations person for the WONCA Working party on Rural Practice and this month the author of the new monthly WONCA Rural Round-up.

WONCA leader Michael Kidd wants to be known as the President who called for a fair go for every person in the world(1).

The WONCA Working Party on Rural Practice applauds him and through our support, resources and leadership want to help work towards a fair go at Health for All Rural People(2).

My Dad sang a song to me as I was growing up:
It's the same the whole world over, isn't it a bloomin' shame,
It's the rich what gets the pleasure, and the poor what gets the blame.
When you look at the state of healthcare around the world, it's the "poor what gets the blame alright", and the rural poor even more so.

Driven by the four horsemen of the rural apocalypse - distance, poverty, workforce statistics, and stoicism; rural health statistics across the globe are appalling.

Rural communities by definition are distant from the services available in urban areas, it takes longer for people to access care. Rural communities tend to be poor communities, people live a hand to mouth existence at the mercy of weather and crops. It can be hard to attract people with health care skills to work in rural places, and the "she'll be right, mate" attitude of many people who live and work close to the land can add to delays in accessing healthcare.(3)

These problems are compounded by the Inverse Care Law which states “The availability of good medical care tends to vary inversely with the need for it.”(4)

Rural people, even in a sophisticated country like New Zealand, have worse expected outcomes for their health than people who live in an urban environment - worse outcomes for cardiovascular disease, malignancy, renal and respiratory diseases and other preventable illness(5).

Rural communities and the governments that serve them would do well to listen to the voices of the health professionals who work in rural areas. Often the people who are living and working within a resource poor environment are the ones who have worked out the best, most pragmatic solutions to deal with the challenges they are facing.

At the WONCA World Rural Health Conferences rural providers get the opportunity to share their stories. In Thunder Bay, in 2012, we developed another statement reiterating the need for communities to be engaged in their health care systems. Perhaps more importantly we had an opportunity to listen to one another’s stories.

Listen to the story of the Australian outback town where an aboriginal health worker, trained in a classical apprenticeship model, developed the skills to perform effective and safe general anaesthetics and surgery under supervision without ever seeing the inside of a surgical OSCE.

Listen to the story of the medical school that takes illiterate sons and daughters of fishermen and gradually trains them through midwifery, nursing and medicine into dedicated rural generalists capable of providing medical care in extremely resource poor environments.

Listen to the story of the medical students on elective charged with providing immunisations to a poor village, seeing the bigger picture and spending their time building boats to get the children from the village they lived in across the lake to the school, saving a two hour round trip through forests.(6)

The Wonca Working Party on Rural Practice has over its 21 years of life developed an amazing resource of such stories translated into pragmatic and evidence based solutions to the issues that face rural communities. Over the next year we will be revisiting many of these documents and thinking about what needs to be done to make sure that those stories are effectively heard.(7)

As members of WONCA, we should all aspire to be expert "Five Star Doctors" - care providers, decision makers, communicators, team members and community leaders.(8) Look at the Health for All Rural People statement, think about the role of women in a rural provider community, consider how best to support and develop effective teams of health care workers in rural communities.

If you have an interest in health for all rural communities remember you are not alone. We need to share our expertise globally and connect with doctors and health care workers who have no one to connect with in their own regions, countries areas. We can use modern communications technology to share and disseminate good practice worldwide.

- join in the conversations on twitter using #woncarural, start a thread on the Wonca General Forums page, come to the WONCA Rural conference, in May 2014, in Gramado Brazil, if you can(9) – and watch out for more opportunities to join with your rural colleagues around the world through the WONCA Working Party on Rural Practice.

Dr Jo Scott-Jones (New Zealand)

1. Kidd M. Family Medicine and WONCA - The Challenges Ahead Bangkok: Wonca Global Family Doctor; 2013 [cited 2103 19/08/2013].
2. Practice WWPR, editor Durban Declaration: Health for All Rural people. 2nd World Rural Health Conference; 1997; Durban: WONCA Global Family Doctor.
3. Strasser R. Rural health around the world: challenges and solutions. Family Practice. 2003;20(4):457-63.
4. Tudor-Hart J. The Inverse Care Law. The Lancet. 1971;297(7696):405-12.
5. Rural Health Indicators Project:Comparison of Five District Health Boards. Hamilton: New Zealand Institute of Rural Health, 2010.
6. Strasser R. Rendez-Vous 2012. 2013;2013(19/08/2013):Conference.
7. WONCA . WONCA Working Party: Rural Practice. 2013.
8. Boelan C. The Five Star Doctor: An asset to health reform? 2013.
9. 12th WONCA - World Rural Health Conference 2013. Available from: