Our cover this month is the painting “Love 2019” by local artist Katka Adams. Katka has explored the refugee experience in her recent exhibition “Coming Home”. She describes her inspiration and motivations below and on Page 15 editor, Robin Osborne details her journey of  escaping the Soviet crushing of the Prague Spring in 1968 and the start of a new life in Australia as “that Czech girl”.

Dislocation from one’s cultural roots is a common experience for many Australians from European, African and even Aboriginal backgrounds. For some art gives voice to their experience, for others it is the written word.

On Page 14 local playwright, Janis Balodis, writes of his own dislocation as the inspiration for many of his works. At different times of his life he has felt either Latvian or Australian, or neither or both.

Light as art is a new aesthetic. The recently redeveloped Lismore Quad has brought this medium to the North Coast. On page 31 Bundjalung elder, Aunty Irene Harrington uses this dramatic canvas to reminds us that many Aboriginal people in the latter half of the twentieth century lost their culture heritage while remaining on their own land.

On 1 June, the first day of Winter 2019, forty clinicians gathered at the University Centre for Rural Health’s Lismore HQ for the Second Nordocs meeting. Once again the major part of the day was devoted to allowing the participants to speak on a topic they felt was of significance to them or to the region.

The “Unconference” format encourages participants to raise issues that are not deemed of significance by health authorities or which do not emerge in community surveys or needs assessments. Often only those deeply involved in an area can see alternatives or better solutions to the problems they confront every day.

As Henry Ford reportedly said, “If I had asked people what they wanted, they would have said faster horses.''

The format differed from the previous year in that the day commenced with a plenary session by researcher and physician, Dr Nick Zdenkoski, speaking on Shared Decision Making with particular reference to the treatment of breast cancer.

The day also differed by concluding with a lively panel session on the issue of whether to call it a “Discharge Summary or Same Day Handover". Associate Professor Kat McLean has written extensively in the Australian medical press on the need for better communication between general practice and the hospital at the time of the transfer of care.

Kat was joined by local GP, Tony Lembke and Director of Medical Services Richmond Cluster, Katherine Willis-Sullivan who gave perspectives on the problem from the viewpoints of primary and secondary care. Also on the panel to give a close up view of the coalface was Dr Sabine Ringkowski who has worked as a junior medical officer in Germany and more recently in the Northern Rivers and Sydney. Our full report on the day appears on page 8.

We are most grateful to the UCRH for providing their venue, and to Northern NSW Local Health District and the North Coast Primary Health Network for their sponsorship support.

The social determinants of health (SDoH) are increasingly recognised as playing a significant role in chronic illness. These determinants can affect a person’s health prior to conception right through to death, and has continuing ramifications thereafter.

The issues often seem insurmountable to GPs but Dr Andrew Binns has co-authored a book on addressing the issue in Aboriginal populations. He also presented at the Nordocs Unconference and gave some practical examples of how to cut through with some patients in desperate need of help. His report on addressing the subject is on page 5.

While those from disadvantaged backgrounds are at a greater risk of drug abuse, it can affect people from all walks of life. Somewhat surprisingly the use of crystal methamphetamine is higher in regional NSW than Sydney. The Special Commission of Inquiry into the Drug “Ice” convened in Lismore in late May, as reported by editor, Robin Osborne on page 20.

Many medical practitioners presented before Commissioner Professor Dan Howard, including local D&A service providers Drs David Helliwell and Bronwyn Hudson. The recently elected member for Lismore, Ms Janelle Saffin, also tendered evidence, arguing for increased rehabilitation services particularly for those members of the Aboriginal community,

After four years the Medical Benefits Scheme Review is drawing to a close. The Review has been driven by internationally known researcher and clinician Professor Bruce Robinson, former Dean of the University of Sydney, Medical School.

Medicine has changed a lot in the 35 years since Medicare was first launched. Stents and statins, laparoscopies and robotics, CT scans and MRIs are routine. Cancers can be prevented through vaccination, cataract removal requiring a two week hospital stay in the seventies is now performed with the placement of an intra-ocular lens resulting in improved vision within a few hours.

It is hard to think of an area of medicine where there have not been significant improvements, yet the remuneration structure through Medicare has remained largely unchanged over this period. On page 17 we delve into the Robinson review, its rationale and processes, and touch on some of its recommendations.

Making changes to a National Health Insurance scheme is fraught and there have been several failed attempts in Australia in the past. While doctors have been accused of “feathering their own nests”, the lived experience of medical practitioners going through the six year winter of the Medicare freeze makes them deeply cynical of the government’s motives.

While change might be needed it is hard to implement as Niccolo Machiavelli noted five centuries ago.

“It must be considered that there is nothing more difficult to carry out nor more doubtful of success nor more dangerous to handle than to initiate a new order of things; for the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order; this lukewarmness arising partly from the incredulity of mankind who does not truly believe in anything new until they actually have experience of it.”

Burnout and suicide is more common in the medical fraternity than the general public. Addressing the social determinants of health is as relevant to doctors as to their patients. The Centre for Rural and Remote Mental Health (CRRMH) has adapted the ‘Act-Belong- Commit’ mental health promotion campaign as one of its key initiatives. Its message is something we should all heed.

Following in the footsteps, possibly literally, of oncologist Dr Adam Boyce, Dr Sally Butchers is raising money for the Cancer Council of NSW through her participation in Stars of Lismore - Dance for Cancer. Given her enthusiasm it is unsurprising that she has raised more than her target of $20,000.

However, it can not be done alone and GPSpeak congratulates Sally and all of her team in a job well done. As Dr Binns has noted, “we all need a sense of purpose in life ... for our own health as well as for the health of others”.