Joys and challenges of working in rural public health
Paul Corben, Director of the North Coast Public Health Unit
Paul Corben is director of the North Coast Public Health Unit [NCPHU], a position he has held in a variety of health organisations on the NSW north coast since 2000. We asked Paul what it’s like to practice public health in a rural area.
Tell us a bit about the PHU in your area
In the current configuration of health administrative areas, the NCPHU covers both the Mid North Coast and Northern NSW Local Health Districts and has offices in Port Macquarie, Coffs Harbour and Lismore. The Public Health team comprises 25 people working across the usual pillars of public health (communicable disease control & surveillance, immunisation, environmental health and epidemiology), as well as a small Tuberculosis Prevention & Control team and the Coffs Harbour Refugee Clinic. We also run the school-based vaccination program which employs a “seasonal” team of about 30 nurse immunisers. As is often the case in smaller rural health organisations, the Director is also responsible for other portfolios which in my case include the HIV & Related Programs teams (55 staff) and the recently established Mid North Coast Research unit (1 staff member).
Give us a sense of some of the communities served by NCPHU
There are approximately 520,000 people living in the NSW coastal area between Tweed Heads in the north to John’s River (a few kilometres south of Port Macquarie). The communities of the north coast are socially quite diverse and on average are socioeconomically disadvantaged. Like many rural communities, the region has an older age profile than many metropolitan areas due largely to in-migration of retirees and out-migration of younger people seeking post-secondary education and employment. There are relatively few people born overseas (about 16.5%) and the region has a relatively large Aboriginal population of about 22,000 people living in regional centres, smaller towns and villages and on former missions. The region is well known for its alternative or “Age of Aquarius” communities notably in the areas around Bellingen and the Byron-Nimbin areas further north and scattered throughout the rural hills and valleys of the north coast. The region’s economic base continues to move away from primary industries of dairying, beef cattle production, horticulture and forestry and has growing health, community services, service industries, tourism and, in some locations, tertiary education sectors. Unemployment is generally well above the state and national averages, especially for younger people.
What are some of the public health challenges on the north coast?
These social, economic and environmental factors contribute to the joys and challenges of public health practice on the north coast. The ever-present challenge in rural areas is distance, even though this area is relatively compact compared to other rural jurisdictions. NCPHU’s main offices are 5 hours’ drive apart, regardless of the route taken or the wish to get there sooner. We deal with this by using technology (videoconferencing and teleconferencing are the norm for team meetings) and the occasional face-to-face get together at a central point – in our case Wonderful Woopi (Woolgoolga). However, we all spend a lot of time driving, often on poor quality roads that reflect the ravages of the weather and the thinly-spread rate base endured by the 12 local government areas within the region.
Another reality of rural public health practice is the large number of media outlets, each keen to get the highly-localised angle on the public health news story of the day to meet their own challenges of filling column space and air time. The flip side is that we can usually rely on our media releases getting a run in all local newspapers and important advice getting radio and TV airtime.
The natural environment, while breathtaking in its beauty, is prone to regular severe flooding and provides ideal breeding and feeding environments for vectors of public health hazards such as mosquitoes, flying foxes that carry Australian Bat Lyssavirus and Hendra virus. The steady spread of residential and commercial development around the major regional centres brings more people into closer contact with these vector-friendly environments, sometimes generating public health concerns.
The “alternate lifestyle” leaning of the north coast presents particular challenges in public health risk communication with notable examples being active anti-vaccination and anti-fluoridation groups that have strong followings in some parts of the region, but thankfully not all. Some community members have a strong distrust of government and can be very quick to declare a cover-up or conspiracy such as we experienced with issues like the Coramba fuel leak, the gastroschisis cluster investigation, concerns about locally-acquired Lyme Disease and the extraordinary concerns about chemtrails. Achieving good public health outcomes in these settings can be particularly challenging, personally taxing and in very rare instances personally threatening. While not peculiar to the north coast, a world where anyone can become an “instant expert” on the basis of a quick internet search means that the challenge of dealing with misinformation grows daily. We acknowledge the rights of everyone to have an opinion and hope that by carefully presenting the public health facts we can provide sound and practical advice to our communities to help protect them from public health threats. A feature of rural public health units is stability and community-visibility of staff. Hopefully most people in our communities accept that those of us working in the NCPHU are just as concerned as they are for the health and wellbeing of our local communities, because we live here too!