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- Public health on the border
- Blending local and global public health practice
Public health on the border
Tracey Oakman – Director Public Health Unit, Murrumbidgee and Southern NSW Local Health Districts (M&SNSW LHD).
Tracey Oakman has been Director of Public Health in the M&SNSW LHD’s for nine years. Tracey trained as a Medical Scientist and worked in pathology for twelve years before moving to the Public Health Unit, where she held several roles in disease surveillance and immunisation, before becoming Director.
Tracey, what drew you to public health?
The pursuit of quality health conditions for all people, regardless of their socioeconomic position is a passion for me. In public health we can work towards ensuring your drinking water is safe, children are vaccinated, infectious disease is identified and transmission is reduced where possible. We also have a role in protecting the public in some emergencies.
Your Public Health Unit had borders with both ACT and Victoria, what if any challenges does this present?
Possibly the greatest challenge is where there are different State policies or approaches to following up a disease or environmental health issue. We have good network links in both ACT and Victoria with a range of agencies and work closely with these counterparts when members of the public from both sides of the border are affected by an issue.
During the 2009 H1N1 pandemic the southern border seemed to be hit first as infected school children returned from Melbourne. While this occurred the PHU staff were also contacts of a case, how did you cope?
The H1N1 pandemic was definitely a challenge for everyone involved. The PHU staff worked long hours and surge staff supported the permanent staff. The Victorian government had some subtle differences to NSW in its approach to the pandemic. Having children based in one State and attending school or functions in the other, made enforcement of policy, particularly quarantining, complicated. It was ironic that some the PHU staff were exposed to the virus via a family member. Rather than quarantining well staff at home, much to their disappointment, exposed staff were quarantined in a way that allowed them to attend home and work only, thus allowing us to continue to function in our public health role.
It’s a long drive from Albury to Bega or Hay, how do you manage a case of communicable disease across such a large area?
There are two main PHU offices, one in Albury the other at Goulburn which give us representation in each District and reduces distance needed to travel. Staff are also located in Wagga, Queanbeyan and Bermagui. We don’t always go to the town where an outbreak occurs, and we don’t need too. Fortunately many outbreaks are contained to a single area. The Public Health Unit staff work closely via telephone, with the District health facilities in all areas. Where there is a need for prophylaxis intervention for a large group of people, usually a PHU staff member will attend the facility and be supported by local hospital or community health staff. In smaller interventions, often the practitioner at a facility will liaise with the PHU over the telephone to administer the appropriate intervention.
In times when we do need to attend the site, for risk assessment purposes for example, we just have to get in the car and drive. Sometimes this means we also have to stay overnight.
In addition to communicable disease issues, our region has a broad gamut of environmental issues to contend with. Our region includes coastal areas, snowfields, irrigation lands, river plains and often drought effected lands. As such the environmental health staff are required to travel a fair bit to ensure environmental health safety.
What is the biggest challenge into the future and how are you going to deal with it?
Due to the geographical spread of the PHU staff, an ongoing challenge is team cohesion, staff isolation and education for consistency and currency of work practices. This is not new, and something we have addressed by regular communication and occasional face to face meetings where possible, but it is difficult at times.
The other challenge would be the slow turnaround time for some pathology results and, in our Districts we have limited specialists. For example, the Districts don’t currently employ an Infectious Disease Physician. Delayed pathology can result in delayed responses, or a response which wasn’t needed if we act immediately, only to find out later the test is negative. We often have to make a judgement call, and generally take a precautionary approach. Limited availability of specialists has required the Public Health Unit to develop links with specialists in other regions where we can seek advice.
Blending local and global public health practice
David Durrheim, Health Protection Director Hunter New England Local Health District
As well as serving as the Health Protection Director in Hunter New England since 2005, Professor David Durrheim works internationally to improve public health, with a particular focus on childhood immunisation, and strengthening outbreak surveillance and response capacity in developing countries. He served on the World Health Organization’s (WHO) Strategic Advisory Group of Experts (SAGE) on Immunisation for 4 years from 2009 to 2012 and continues on a number of SAGE working groups, particularly for measles and rubella, and ebola vaccines.
Dave also serves as the Chair of the Western Pacific Regional Measles Verification Commission; is a regular advisor to the Technical Advisory Group on Immunisation in the Western Pacific; and also advises the Pacific National Focal Points for International Health Regulations.
He has put down solid roots in Australia, having been the Head of School of Public Health, Tropical Medicine and Rehabilitation Sciences at James Cook University and Director of the WHO Collaborating Centre for Control of Lymphatic Filariasis, Soil Transmitted Helminths and other Neglected Tropical Diseases before relocating to NSW. He currently chairs the Australian National Polio Certification Committee and has recently been appointed onto ATAGI (the Australia Technical Advisory Group on Immunisation).
Dave, you grew up in South Africa – what were some of the things that inspired you to study medicine?
I was really fortunate to grow up in a privileged South African family but from very young my parents instilled in me a strong moral obligation that “to whom much is given, much will be required”. Medicine seemed to be the most effective way of delivering on that obligation.
Why did you specialise in public health medicine?
After finishing Medicine, the intellectual thrill of Neurology saw me embarking on a Registrar job in a large hospital with a neurological unit serving about 8 million rural Africans in the north of South Africa. Disenchantment with the relatively low return on investment of futile adult neurological escapades, in a sea of preventable infectious childhood diseases, and a wonderful offer from a UK university saw me leave to study Public Health Medicine in London. I returned to take up the Communicable Disease Control Director’s position in Mpumalanga Province at the time of South Africa’s first democratic government under Nelson Mandela in 1994.
You have a particular passion for immunisation – what are some of the international initiatives you have been involved with?
Nothing better epitomises the best of preventive medicine than immunisation, particularly of infants. Those at greatest risk, often the poorest of the poor, generally benefit the most. And to prevent a child’s death (or 13.8 million deaths between 2000 and 2012 due to measles vaccination alone) is incredibly satisfying. Nelson Mandela was and is a great inspiration to me. He said: “There can be no keener revelation of a society's soul than the way in which it treats its children.” We have to make sure that all children benefit from the wonder of immunisation.
Some of the decisions I was privileged to contribute to through my work with SAGE resulted in: an expansion of rotavirus vaccine availability in developing countries; deployment of cholera vaccine in specific epidemic responses; applying a single dose hepatitis A immunisation strategy for population-wide protection; and the rollout of meningococcal A vaccine in African meningitis belt countries.
HNE has developed special links with the Pacific – why and what are you doing there?
I was fortunate to work with a number of Pacific Island Countries (PICs) on vector-borne diseases while at James Cook University and, for the past decade, with PICs on outbreak surveillance. With the need for all countries to meet their International Health Regulation requirements it became clear that additional support would benefit many developing PICs. A partnership between HNE, WHO and the Secretariat of the Pacific Community was successful in attracting a sizeable DFAT Australian aid grant to further strengthen the surveillance and outbreak capacity of PICs over the next three years. This has seen HNE team members working closely with our PIC counterparts to enhance capacity and share experiences.
Are there any lessons for us in NSW?
We should never take for granted the wonderful public health resources we have locally. But it does place on us an obligation to expend ourselves extravagantly for the benefit of those communities with the greatest need in NSW, Australia and our Region. As Madiba said: “There is no passion to be found playing small, in settling for a life that is less than the one you are capable of living.”