Rural round-up : from Norway to Rio: three locations, three messages

John Wynn- Jones reports:

I have just returned from a remarkable international symposium in Norway on the research associated with generalism in rural practice, which was hosted by the Centre for Rural Medicine at the University of Tromso. The symposium added to the impressive work that came out of the 2 Rural Generalist Summits held in Cairns in 2013 and in Montreal in 2015. Although the term rural generalism appears to be new, it is really a reaffirmation of the fact that doctors working in rural & isolated communities are by nature generalists. Good rural doctors, who have such a wide scope of practice have to be good generalists.

Rural health services, medical training and health seeking cultures vary from country to country and so must the work and responsibilities that rural generalists take on. Generalism depends on the context and the needs of the communities that the health providers serve. Isolated communities in Australia and Canada must have family doctors and hospital proceduralists who are competently trained and resourced to manage medical, surgical and obstetric problems & emergencies.

On the other hand more centralist health services in Europe, where distances may not be as great must also demonstrate competences that their urban colleagues do not need. Although some of the skills are different, rural doctors worldwide will need to be competent in managing chronic diseases (with complex co-morbidities), psychiatric crises, palliative care, trauma and emergencies when the back up from the secondary sector is just not there. We await the final report but there is no doubt that the concept of generalism is resurgent and it is diametrically opposite to the wave of specialisation that is driving health systems around the world.

Recruitment and retention has long been one of the major barriers to safe and quality rural healthcare around the world. To a certain extent, Europe has been immune to this trend until recently. The impact of urbanisation, austerity brought on by the financial crisis, medical migration and traditional urban focused academic curricula and training programmes has led to a deepening crisis in the heart of rural Europe. Some countries especially those in central and eastern Europe are appear to have been affected more but no country seems immune to the problem.

The European Rural and Isolated Practitioners’ Association (EURIPA) will be gathering in Marseilles at the end of this month for their annual EURIPA Rural Health Forum and the theme of this year’s forum is “Being a Young Rural Doctor”. The meeting will focus on what needs to change in Europe to ensure that the present aging medical workforce will be replaced by a new generation of motivated, skilled and rural orientated young doctors. The forum will also focus on care issues such as palliative care, chronic disease management, practical clinical skills & paediatrics as well as management issues such as out of hours care, teamwork and practice management. Jean Pierre Jacquet and his team have produced a great programme, so please check it out.

The final and third message is that Rural WONCA will be changing its structure and format when we meet in Rio for the 21st WONCA World Conference of Family Doctors in November. At our working party meeting in Prague three years ago, we committed ourselves to making sure that RuralWONCA met the needs of all doctors working in rural areas around the world and not just those who could afford to travel to conferences and meetings. We aim to ensure equity from the perspectives of gender, geography, demography and generations. Our current structure, which had worked so well until now could not cope with the added interest from around the world that has come as a result of our social media groups and contacts. WONCA has seven regions and it is our intention that we should grow our regional contacts, with each region represented within the new structure.

The new configuration will have three levels:

• A general assembly where everyone with an interest in rural practice can attend. The assembly is geared to ensure that we in Rural WONCA can keep you up to date with our activities and at the same time, give you the opportunity to tell us about rural innovations that you are involved with and suggest future activities. Those wishing to join the Rural WONCA Council can declare an interest during the assembly.

• The Rural WONCA Council will be a smaller meeting and it will concentrate on business issues. There will be places for observers but we will need to hear from you beforehand. It is our intention that the council will represent all 7 regions of WONCA and that there will be a student, young doctor and at least one woman representative from each region.

• The WONCA Executive will remain much the same and it will ensure the smooth running of the organisation.

We are excited about the future and the responses that we have had from many of you have been positive. The Assembly will be held at the Windsor Barra Hotel, Rio de Janeiro on Tuesday 1st November from 12.30 - 5.30pm and the Council meeting will be in RioCentro Conference Centre, Wednesday 2nd November from 8.30 am to 5.00 pm (Room 103A, First Floor) Invitation is extended to current Council Members to attend and Observers are also welcome (Please let us know beforehand as places are limited) We want you to come and tell us what you want us to do for rural practice in the future.

Finally we will all also be traveling to Rio to learn and we have an exciting rural programme for you, covering a host of pertinent rural issues. Each of our 10 events will be highlighted at Rural WONCA events in the programme and they can also be found on the WONCA website. You can also come and meet us at the Rural WONCA booth in the main exhibition (Look for us in the WONCA Village) and we hope to see as many of you there as possible.

So see you in Rio and please put Tuesday 1st & Wednesday 2nd November in your diaries as soon as possible.

John Wynn-Jones
Chair WONCA Working Party on Rural Practice