Dr Wiktor Szczudlinski is a general practitioner who qualified in Poland and is now working in Scotland.  He shares his experience of working as a rural GP, why he decided to leave rural practice, and how he has gotten more involved in health tech and consulting with health tech start-ups.   Episodes summary: 00.40  Dr Szczudlinski talks about his experience moving from Poland to rural Scotland 03.35  What were the challenges while working in rural Scotland? 05.30  Who were the members of the wider healthcare team? 08.30  Were there any specific challenges to caring for the local community? 10.15  How was the work different in the summer compared to the winter? 11.30  How would you compare rural and urban practice? 15.30  What factors influenced his decision to move to a more urban area? 18.30  Why did he decide to become more involved in health tech and entrepreneurship?  22.00  What has he learned about health tech?  How can digital solutions be implemented in rural areas? 35.50  Top tips for people thinking about a rural health career     Key messages: Mixture of work as a rural GP - usual GP clinic, out of hours/urgent care, and working in a small local hospital. Support via telemedicine with a larger hospital center and good connections with emergency retrieval services. The job provides a lot of variety, you are well supported and feel part of a team. Local community works in professions where there can be serious injuries.   People can present late with symptoms as they often try to carry on, this can lead to more advanced  No additional staffing in the summer despite an influx of tourists.   Workload is different in urban vs rural - people assume that the workload will be less in rural areas, this is not the case, distances make a difference, it can take a long time to do a home visit.  There can be a lack of infrastructure such as mobile network access, this can make it challenging to call for help in an emergency and it can take longer for help to arrive.  Fewer resources are available in rural areas.   The assumption that it is less busy in rural medicine is not the case, the number of the tasks may be lower but the time needed for those tasks is longer.   You need to be more confident in your skills and go outside your comfort zone, there is a big element of urgent and emergency care.  You need to be prepared - anything could happen. Family factors played into the decision to leave rural practice and move to a more urban area.  Housing is a big problem in rural Scotland. When AI started becoming more prominent he started learning more about this, writing about what he was learning on LinkedIN.  Started to be contacted by health tech founders and started consulting and sharing his healthcare experience. Doctors often do not pay attention to things outside of medicine.  It can be important to step out of your comfort zone and learn something new. We need to pay attention to what is happening with tech and AI as we will be seeing more of that.  There is scope for these tools to free us from mundane tasks and paperwork.   Digital solutions may be implemented faster in rural health as there is a long history of using telehealth in these areas.   There is a need for digital solutions in rural areas as there is a lack of doctors, this can be a solution to help provide care with the support of other members of the healthcare team. When the only doctor on the island gets snowed in for a few days, the only solution is to provide remote digital consultations.   Give rural medicine a try, it can be an adventure in beautiful surroundings and you become part of the community.     Thank you for listening to the Rural Road to Health!

Dr Jaka Strel is a rural family doctor from Slovenia.  Dr Strel and his team have built a very successful medical practice in Ziri, which has helped Ziri win the title of healthiest municipality in Slovenia. Episode summary: 01.00  Dr Strel shares his journey into family medicine and rural health 05.15  Specialization of family medicine in Slovenia 08.45  How is the primary care system organized in Slovenia? 14.20  Who are the members of the family medicine team? 15.00  What are the characteristics of the community he is caring for? 19.45  What challenges is rural medicine facing in Slovenia? 21.40  What health challenges to rural communities face? 22.30  What is different about the approach they are taking in Ziri? 27.00  How did they make Ziri the healthiest municipality in Slovenia? 31.30  Who were the key partners to make this approach possible? 34.30  Were there any barriers and challenges to trying this new approach? 38.00  Will this approach with a focus on preventative care be expanded nationally? 39.35  How has the community responded to this approach? 40.30  What lessons has he taken from this experience?   Key messages: His rural family mentors during his early years of training influenced his choice to become a family doctor. Health system is organized into three levels: primary care, regional hospitals and tertiary centers. Primary care includes family medicine, pediatrics, gynecology, dentistry and emergency medicine.   Primary healthcare is organized around 60 healthcare centers, under the auspices of local municipalities. “Concessioners” are doctors that have a contract directly with the National Health Insurance Company.  They can work within the local healthcare center. 20% are rural clinics, most of them are located in health stations which are part of health centers.  Some rural clinics are run independently by concessioners. First health center in Slovenia was established in 1930 with the goal of uniting providers for primary care and preventative care. The community has a positive attitude towards sports and physical activity which has been accredited to the local primary school and the educators there.   There is a lack of rural medical education, at present education in this area depends on good rural mentors.   There is no extra funding provided for rural practice despite there being higher expenses for work in rural areas. Two challenges for the health of the community have been alcohol abuse and bone fractures in the elderly. They work with different partners within the community such as the local government, schools and other community organizations. Three important areas that they work on: prevention, flexible curative healthcare, good information support and optimized processes.   ZirFit - a health promotion activity organized with sport experts, primary school leaders and people from industry.  Organized measurement of 12 parameters of physical fitness such as strength, balance and agility.  This happens every year on the third weekend of May.  Usually attended by about 100 people.  After the testing the patients receive advice from a kinesiologist and doctor on how to optimize their health.  This is the key to success - working with the community.  The health center has made significant improvements to the health of the community - lower overall mortality, higher vaccination rates, high participation rate in preventative programs.   Local companies, sport clubs, and community clubs were important partners who helped to support this approach to community health.  Relationships were established through individual meetings.  It is important to be patient and think about the perspective of the people you are talking to so that you can find a united way to work on things with the community. It is important to meet regularly with all of the community partners. There are always challenges, especially when you are doing something new. Biggest challenge was to find suitably motivated colleagues with the right professional knowledge and personal qualities.  Decided to grow the team gradually.  It is important to have a good team and take care of their wellbeing and opportunity for personal and professional development.  Challenge of COVID-19 pandemic, stopped many preventative activities. Challenge with funding of their programs for preventative care as there is no national system funding for these activities.  They have had to find alternative sources of funding to do this. There has been a positive response from the community.   Lessons that he has learned on this journey: The importance of having a supportive family and team, colleagues that you can rely on.  There  is always a way forward, perseverance and some times stubbornness is necessary. Patience and prudence.     Top tips for people thinking about a rural health career: Take care of yourself.  We work hard and we have to rest both physically and mentally.  Take care of physical fitness and mental health, it is essential Have a hobby that relaxes you and helps you clear your mind. Important to have a team of colleagues who are prepared for different scenarios, that are dedicated to their work and are adept at collaboration.   Collaboration with the local community is crucial.  Relationships with the community must be nurtured.     Thank you for listening to the Rural Road to Health!

Melanie Hartmann is a healthcare worker with a bachelor degree in interdisciplinary healthcare and management from Germany. She has been reseaching primary care netwroks on the Halligen Islands.  She talks about the unique way in which primary care has been organized on the Halligen and the insights that she has gained during her research.   Episode summary: 00.55  Melanie tells us about her professional background and how she got involved in rural health 02.50  How is primary care organized on the Halligen Islands? 06.20  What are the characteristics of the community? 09.10  What are the different roles of nurses on the Halligen? 11.30  How do nurses reach the people on the smaller islands? 13.30  What are the challenges to access healthcare? 16.15  What challenges do the nurses face working on the Halligen? 19.55  Melanie talks about the research that she has been doing about primary care on the Halligen 25.00  How does local identity impact the provision of healthcare? 27.00  How does local culture and identity affect healthcare workers that are coming to work in these communities? 29.00  Top three tips for people thinking about a rural health career   Key messages: There are no doctors based on the Halligen, they visit once every two weeks.  Nurses lead the primary care on the Halligen for a population of about 300 people.  In summer there are a lot of tourists, this is important when considering the healthcare that is needed during the summer months.  The population can more than double.  In winter fewer ferry connections to the mainland than in the summer.   Nurses are the most important interface between primary and secondary care, they are parts of the community.  They rotate every 2 weeks on the larger islands and they are present on the island 24/7.   First aid responders (members of the local community) exist on the smaller islands and they have some limited equipment available and provide basic emergency care while waiting for further help to arrive.  Leaving your home to receive healthcare requires a great deal of effort, personal and cognitive resources - not everyone has these.   The community on the Halligen were the first community to be fully vaccinated for COVID-19 as the nursing team knows the community and where everyone lives. Nurses that work on the Halligen are highly trained.  They are all emergency nurses and have developed further skills on the job.  How can networks help to secure healthcare and how can they make healthcare better? On the Halligen the importance of community nursing is on full display.   Local identities are important, there are those that have lived there for a long time and those that have recently moved there.  This results in very different expectations from healthcare.  Every community has its own identity.  You have to find a shared goal with the community. It is important to have a good understanding of the local environment and the social determinants of health that impact on the community and individuals.  Top 3 tips: 1) Look at and understand the community identity on site as you are often an outsider.  2)  Develop trust. 3) Prioritize goals which connect with the identity of the community.   Thank you for listening to the Rural Road to Health! Rural Health Compass - Navigating Rural Health and Policy

Dr Bita Barghchi is a primary care doctor from Iran.  In this episode she shares her experience of working in rural Iran and talks about some of the challenges faced by rural communities and healthcare workers.   Episode summary: 00.45  Bita tells us about her professional background 01.45  How is the primary care system organized? 03.15  How do patients access secondary care and other health services? 05.40  What were the characteristics of the community Bita was working in? 07.50  How were emergency cases managed? 11.40  What are the main challenges facing rural communities in Iran? 13.45  How are healthcare workers managing the high workload and burnout? 19.00 What has the transition been like to Australia?  What are some of the differences between Iran and Australia?    Key messages: Health houses with qualified GP, nurse and midwife make up the core primary care team. People do not like to be referred to secondary care as this often incurs a payment for the service. People can choose to visit a specialist without getting a referral from primary care.  This can lead to visits to the wrong specialist. Important to be patient when working in rural areas and develop a good relationship with the community. More health education needed for school aged children.  Poor coverage for women’s health.  High levels of suicide among doctors in Iran, particularly among younger doctors.   Pressures on the workforce are leading to health workforce migration. One of the biggest differences between Iran and Australia is that all patients, including women, are able to make decisions about their health.  Important to be patient and respectful towards rural communities, be adaptive, and develop good relationships.    Recent article about doctor suicide in Iran: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00530-0/fulltext   Thank you for listening to the Rural Road to Health!

Prof John Wynn-Jones and Prof Mark Gussey are the co-chairs of the 13th EURIPA Rural Health Forum which will be held in Lincoln in June 2024.  They will tell us more about this upcoming event and their aspirations for the Forum.   Episode summary: 01.15  Prof Gussey shares his journey into rural health 03.40  Prof Wynn-Jones shares his journey into rural health 06.55  What is EURIPA? 08.15  What is special about EURIPA Rural Health Forums? 09.35  Lincoln and the International Institute for Rural Health 13.15  What does the Institute mean for rural health in Europe and beyond 16.40  What is the theme of the EURIPA forum? 19.25  What should rural primary care focus on in tackling inequalities?  21.25  What is in store for the social part of the EURIPA Forum? 26.15  Who is the Forum for and who should attend? 29.45  What do the Co-chairs hope will be the outcomes of the EURIPA Forum? EURIPA Rural Health Forum - Lincoln, UK June 20-22 2024 Theme: Tackling Health Inequalities in Rural and Remote Communities https://forum.euripa.org/   There are 4 bursaries available for students and young doctors.   Keynote speakers:  Dr Toni Dedeu - Senior Advisor for Integrated Primary Care with the World Health Organizations Dr Pauline Wilson - Consultant Physician on the Shetland Islands   Abstract submission open until 7th April. Early Bird registration until 19th May. Thank you for listening to the Rural Road to Health!

Prof Lionel Green-Thomson is the dean of the Faculty of Health Sciences at the University of Cape Town in South Africa.  He is also a member of the board of directors at the Network Towards Unit for Health.  We will be talking about the upcoming Ubuntu 2024 conference.  This conference is jointly organized by 5 Universities in South Africa, Rural WONCA and the Network Towards Unity For Health. The theme of the conference is People, Place and Policy for Community Wellness. Ubuntu 2024 will be held in Cape Town, South Africa from the 10th to 13th of September 2024. Episodes summary: 01.15  Prof. Green-Thomson tells us about his professional background 04.45  What is the Network Towards Unity for Health? 08.05  How is the University of Cape Town involved in rural health training? 13.30  What is the story behind Ubuntu 2024? 19.15  What is planned for Ubuntu 2024 and how will people, place and community for wellness be explored? 23.35  Who is Ubuntu 2024 for, who should attend? 28.10  What social events are planned for Ubuntu 2024? 32.15  What does Prof Green-Thomson hope for as an outcome of Ubuntu 2024?   Key messages: The Network Towards Unity for Health - a network of networks.  It provides education, building social accountability measurement tools, and provides a social accountability fellowship.  It has vibrant student involvement and engagement.  A person is a person through other people - Ubuntu. Communities have said that future clinicians need to learn about Ubuntu -“if this is not taught how will they love and respect us?” Increasingly recognising that the stories of indigenous people have not been told. Social and health policies for public good - can we put the ideas of health into every policy that governments and institutions create. The ongoing challenge is educating the health workforce. We get caught up in the quality but do not always wrestle with the relevance as much as we should.  Addressing power dynamics within the workforce.  Addressing social and environmental sustainability will be an important theme.  Ubuntu 2024 would like to see a strong community voice at the event, people from community organizations, indigenous communities, policy makers and people living and working in different regions of the world.    Ubuntu 2024: https://ubuntu2024.com/ The Network Towards Unity for Health: https://thenetworktufh.org/ Rural Wonca: https://www.globalfamilydoctor.com/groups/WorkingParties/RuralPractice.aspx  Rural Seeds: https://www.ruralseeds.net/ Student Network Organization: https://snotufh.org/   Thank you for listening to the Rural Road to Health!

Prof Nuno Sousa is a neuroradiologist and the Director of the P5 Digital Medical Centre in Portugal. This centre has been developing digital health solutions to support the provision of healthcare in rural areas in Portugal. Their projects have been developed in close collaboration with the local communities they work with.  Episode summary: 01.00  Prof Sousa tells us about his professional background 06.00  What is P5 and what work has been done there?  09.20  What types of services are being provided?  20.10  What have the benefits been for rural communities? 26.30  Who have been the local mediators in rural areas?  28.50  How many consultations are provided?  31.15  What has the response been from the health providers?   34.45  Have there been challenges within the health system? 39.45  How do we scale and spread innovation?  43.45  What are some key insights from Prof Sousa’s research about aging? 54.15  What does Prof Sousa see for the future of digital health?      Key messages:  Created a clinical digital center (P5) to work in partnership with other healthcare providers and the local communities.   P5 is a way to give back to the community within which the center is working.  Embedding digital tools and technologies within the way we practice medicine. Three main goals of P5: 1) to ensure that medical students are trained in a digital health setting, 2) reaching further and improving the quality of care, 3) promoting research.   Empowering patients is at the core of what P5 is doing.   Promotion of health - engaging with local institutions, such as schools, to tackle issues that these institutions ask for help with.   Large demographic shift is happening in Portugal, emphasis on promoting healthy aging programs to improve quality of life.  Health promotion activities are run in parallel with activities for health literacy and digital literacy.   Integrators of solutions rather than creators of new solutions.  They have searched for solutions that already exist that can be adapted to the local context.   Digital palliative care program - multi modal program adjusted both to the patient and the caregiver, currently in the pilot stage. Allows for continuous monitoring and support.  Initial meetings/consultations should still be face to face to help develop trust and this allows for better integration with the digital services.   Establishing partnerships with local municipalities has been important to the success of the program.  Digital removes the barrier of distance.   People prefer to express themselves in their mother tongue when they are unwell, for this reason P5 provides services to patients around the world. People who use the services in urban areas are much younger than the people who use the services in rural areas.  In rural areas the interaction is not as easy due to technical obstacles such as digital literacy.   P5 has been meeting local people in local parishes, libraries and pharmacies to develop local mediators for communication to help people use the digital services.  The acceptance of the services can be slow.  P5 does not provide acute care, they focus on health promotion and monitoring of chronic decisions.   Local champions help to spread the word and support the adoption of the service.  Adoption is always growing but is very slow.   Mental health support has had good adoption particularly among younger people.   With older people the use is tied to the recommendation of the local health provider as there is an element of mistrust.   They found it was very important to engage with health professionals from the start and include them in the development of the program.  If this was not done the engagement with the services were not very good.   Digital literacy also needs to be developed among healthcare professionals.  New services need to reduce workload of healthcare workers not add to existing workload, this causes barriers to implementing new services.   Digital health is still seen as a side element and there are major barriers to integration.   A need for more tolerance and flexibility when looking at innovation. The health system can be very rigid which slows down the process of innovation.   Implementation science around healthcare services and processes is important if we want to move ahead.  The problem is if we are rigid in only giving one option of implementation, this can lead to dead ends.  Developing an ecosystem that allows them to explore healthy aging of the brain.   Could we develop interventions that improve mood which would improve cognitive function?  Social isolation negatively impacts cognitive function, it can decline dramatically in a short period of time.  Digital tools are not the enemy but the way for us to more effectively reach more people. P5 had built on the process of P4 medicine and added proximity.     P5 website: https://www.p5.pt/    Please like and share this episode.  If you want to learn more about the podcast go to theruralroadtohealth.blog  To share comments or reach the host: ruralroadtohealth@gmail.com  Thank you for listening to the Rural Road to Health!

Dr David Halata & Dr Katerina Javorska are rural family doctors form Czechia. Both of them have been involved in an initiative to improve rural healthcare in Czechia called Go Rural. Dr Halata is the chairman of the Working Group for Rural Medicine in the National society for Family medicine and creator of Go Rural. Dr Javorska is a member of the Working Group on Rural Medicine and has been working with students and young doctors in the Hradec Kralova region. Episode summary: 00.50  Dr Halata and Dr Javorska tell us how they became rural family doctors and their professional background. 06.20  How is the primary care system organized in Czechia? 11.50  What are the rural health challenges? 17.15  Why did they start a rural health working group in their national society? 20.35  What is Go Rural? 23.55  What have the outcomes been from Go Rural? 28.30  Project in Hradec Kralova 36.00  Where there any challenges to developing the program? 37.20  Is the program having an effect on the development of rural health? 38.45  What have you learned from these projects? 44.15  What is their advice to others who would like to set up similar program? 48.50  What have they most enjoyed about being a rural doctor and their top tips?   Key messages: Primary care - primary care pediatrician, family doctor, primary care gynecologist, and dentist. Family doctor team was traditionally made up of a doctor and a nurse.   More recently some practices have started to develop primary care teams with additional staff. There are two different health care systems, one around university hospitals and another around local hospitals.  Availability and quality of care varies in different parts of the country. Challenges in providing care for Ukrainian refugees, it was important to build trust with them to provide them with good quality care.  Lack of rural GPs, senior colleagues have retired and no new doctors have taken their place.  This has left a lot of patients without a GP. Many issues faced in rural areas internationally are similar such as the shortage of rural GPs.   The Working Group for Rural Medicine was established in 2016.  It was important to base their work on data, a lot of things had been made on assumptions rather than data.   Go Rural started in 2018 and focused on students and young doctors to address the rural doctor shortage.  Survey showed that money was not the main motivator, other factors like schools for their children and jobs for their partners were more important.  The pilot program was focused on promoting rural medicine and organizing short fellowships in rural practice.  There has been a high interest from medical students for the short rural internships.   Longitudinal rural clerkships have been shown to attract doctors to work in rural areas. These are not available at present. The pilot program of Go Rural was run without funding and expenses were covered by the family doctors who were hosting students.   Finding the right mentors to host students was very important to showcase positive examples of rural practice.   Hradec Kralova Project received some funding from the local government, this supported the development of the project by covering costs for mentors, and allowing students to attend a conference. The project started with 15 participants.  Students were surprised by the variety of clinical presentations and work in rural practice.  These projects have helped to support further development of rural health in Czechia and they are now applying for a grant to start a national program. Following the projects a number of participants became rural doctors.   Larger resources are needed for nationwide impact.  The smaller projects showed that the approach was correct and effective.   There is a need for research in rural practice and good collaboration with universities. With data they were able to approach the ministry and ask for their support.  Without the data this would not be possible. A focus on GP trainers is needed in the future and develop them as teachers in general practice.  Advice for starting a similar project: Important to engage and identify the needs of young doctors.  Collect data from the local context. Focus on the quality of the internships and the mentors.  Involve them in real rural work.  The project needs to be fun for students and young doctors.  Engage students in promotion of the project and involve them in project development. Focus on international cooperation and events.     Contact information:  Dr David Halata: https://www.facebook.com/ordinacehostalkova/ Dr Katerina Javorska: https://javorskysro.cz/    Please share and like this episode.  If you wand to learn more about the podcast or share any comments you can do this via email ruralroadtohealth@gmail.com or at theruralroadtohealth.blog  Thank you for listening to the Rural Road to Health!

Dr Sara Bradley is a postdoctoral researcher at the University of South Wales. Prior to this position she was a postdoctoral research fellow at the University of the Highlands and Islands, in Scotland working in the Division of Rural Health and Wellbeing.  Her work focuses on social prescribing, rural service provision, mental health and wellbeing and community engagement and co-production. Episode summary: 01.00  Dr Bradley shares her professional journey 02.30  What is social prescribing? 04.40  What kind of social prescribing has there been in the highlands and islands of Scotland? 07.05  Why is social prescribing administered by volunteer and community groups? 08.00  What are the challenges for rural and remote social prescribing? 11.05  What were Dr Bradleys key insights from her research? 15.30  Examples of how social prescribing helped a community 19.00  How does social prescribing integrate with the primary care system? 22.45  What would need to happen to make social prescribing more sustainable in rural/remote areas? 22.20  Does social prescribing depend on the local community? 26.30  What motivates the third sector to work on social prescribing? 28.20  Are there resources for rural prescribing?   Key messages: There are a lot of non-medical factors that affect peoples’ health and wellbeing. Social prescribing tries to address these non-medical factors, it is a holistic approach of trying to tackle these factors in the community and with the community.  Increasing confidence and self esteem allows participants to go on to do other activities and become more active in the community.   Social prescribing does not fit into conventional healthcare culture so there is a lack of capacity and funding within the system, for this reason third sector organizations take on these activities.  Challenging to provide consistent social prescribing service in remote and rural areas, there is poor access to public transport, poor broadband coverage, lack of capacity.   Rural and remote areas may not have enough people with similar issues to create a social prescribing activity, this has implications for fundability and continuity.  COVID19 had a big impact on volunteering, often volunteers are retired people who had more risks at this time.   Challenges: health service culture, patients and professionals do not know enough about social prescribing, referral pathways which are variable and complex, community link workers are employed in different ways, severity of people's needs, health inequalities are entrenched, funding structure, difficult to maintain continuity. Great potential for many benefits of social prescribing.  Prescribing heritage based interventions through rural museums - drew attention to the need for co-productions in rural contexts and that projects need to be adapted to them. Danger of widening health inequalities if something is provided in one place but other surrounding communities don’t have any activities.  Person centered approach works very well.  Link workers can help connect the primary care system with social prescribing activities.  Clear referral pathways are needed.  Sustainable and longer term funding is important to help make social prescribing successful.  Funding, recognition and support are vital for sustainable social prescribing.  The third sector recognises that there is a great need for social prescribing, more so after the pandemic.     Contact: sara.bradley@southwales.ac.uk  Wales School for Social Prescribing Research  Home (wsspr.wales)  Scottish Social Prescribing Network -  SSPN – Scottish Social Prescribing Network (scottishspn.org.uk) Voluntary Health Scotland - Scottish Community Link Worker Network - Scottish Community Link Worker Network (vhscotland.org.uk)

Professor Steven Orozco Arcila joins us from the University of Antioquia in Colombia. He teaches a range of subjects including public health, primary care and health promotion. In this episode we explore how conflict has affected the provision of healthcare in rural areas of Colombia. Episode summary: 01.00  Prof. Orozoco Arcila’s professional background 04.10  How does conflict impact the health and wellbeing of people? 08.20  How has the prolonged conflict affected the country? 10.30  What happens when healthcare workers are sent to work in rural conflict areas? 11.30  Is the conflict more prevalent in rural or urban areas? 12.50  How have rural areas been affected by the conflict? 14.20  Do people move to more urban areas due to the conflict? 15.45  How is this affecting the healthcare system in Colombia? 18.20  Can the country address the challenges? 21.00  What happens after the conflict has ended in an area? Key messages: Colombia has the longest internal conflict in the world.  Armed actors have control of many rural areas of the country for a long time, controlling movement, economic opportunities, and when people can access health services. Health workers often do not want to work in these areas as their life is in danger and they are under pressure from illegal actors.   Attacks on medical missions happen in these rural areas, health personnel have been murdered.  Illegal actors are blocking the transit of supplies and can also take these supplies. Lower vaccination coverage and higher prevalence of infectious disease in areas where conflict is more prevalent.  Constant presence of paramilitary in territories including in the hospital.  Seeing many people wounded and killed, health personnel were displaced.   Rural service is a mandatory step to be able to attain medical credentials. Conflict is more intense in rural areas as this is where the natural resources and strategic corridors are.   Conflict has produced approximately 9 million casualties, about 80% of them in rural areas.  About 9 million people have been displaced within the country.  More than 34 000 people were kidnapped, there are 190 000 missing people.  Most of this is concentrated in rural areas. People are coming to the cities without any possessions, they usually contribute to an increase of poverty and unemployment in the cities. Weak presence of the state in rural areas in relation to education, health and other public services.  This is increasing inequalities. Weak health systems in rural areas of Colombia.   In areas where the conflict has ended the communities can live better and start their lives again.   Drug trafficking is the main cause of the ongoing conflicts.   Farmers in conflict areas were made to produce coca leaf, when the conflict ends, crops will be destroyed but no new opportunities or support is provided, this can fuel new cycles of violence.     Email: steven.orozcoa@udea.edu.co    Please like and share this episode. If you want to contact me you can do that via email at ruralroadtohealth@gmail.com or at theruralroadtohealth.blog  Thank you for listening to the Rural Road to Health!

Dr Cath Cosgrave is a rural change-maker, strategic advisor, trainer, coach, presenter and evaluator.  She has more than 25 years of experience  working with rural communities developing community-centred, strength-based strategies to effectively address local health and community service issues. Attract Connect Stay website - https://attractconnectstay.com.au/   Episode summary: 00.55  Dr Cosgave shares how she became involved in rural health 06.15  What are the challenges facing rural communities when trying to retain a health workforce?  08.30  What is the attract, connect, stay framework? 20.50  How does the framework work at a practical implementation level?   22.50  The community connector program 36.15  What has the community response been to this approach? 40.45  What have the key learnings been? 45.20  Is the framework transferable to other countries?   Key messages: What influences decisions to stay or decisions to leave a rural community?  Attraction of health workers is a major barrier.  Nursing is a bit better as training happens locally.  Doctors tend to be from out of area. Life stage, career stage and degree of familiarity with rural living/place - the three main factors influencing recruitment and retention. Health professionals start to weigh up if they will leave or stay around the 12 months into a new position. Early careers are interested in career development and support Middle life, family stage, flexible career opportunities are important. Senior professionals, interested in leaving a legacy and have fewer family commitments.  Support needed for healthcare workers to settle and connect with the community.  The framework focuses on three areas: 1) Friendly and supportive workplace. 2) Building career pathways in the local region.  3) Social connections and sense of belonging.  All three need to be addressed. Retention is different depending on life stage, if you are getting two years out of early career professionals that is very good.  Life stage is the most important determinant for decision making. Very difficult to attract mid-career professionals as everything needs to be tailored to the whole family.  Community connector program- to help the professional and their family integrate well with the community.   The community connector is always recruited from the local community and use their knowledge of the local area and their social connections to help support the health professional and their family. Lack of funding is often a barrier to implementing new initiatives.  People experience rural communities as warm and friendly but not as inclusive.  Rural communities need to look at ways to modernize to support diversity. How well does the person fit and how well can the community support them? This is important to ask and think about.  The need to be patient, it is a cultural change program at organizational change and community level.   Ensuring that it is sustainable. Key stakeholders need to learn to work well together.   Here is the Attract Connect Stay -Self-Assessment Checklist, which helps health or social care organisations identify the areas may need help with implementing the framework. Take a look here.People can book a free 30 min workforce strategy meeting with me here https://attractconnectstay.com.au/contact/A list of my peer reviewed publications can be found at  https://cathcosgrave.com/publications My most relevant papers are: Cosgrave, C. (2020) The Whole-of-Person Retention Improvement Framework: A Guide for Addressing Health Workforce Challenges in the Rural Context, International Journal of Environmental Research and Public Health, 17(8), 2698.https://doi.org/10.3390/ijerph17082698 Cosgrave, C., Malatzky, C., & Gillespie, J. (2019) Social determinants of rural health workforce retention: A scoping review. International Journal of Environmental Research and Public Health 16(3) 314. https://doi.org/10.3390/ijerph16030314 Cosgrave, C., Maple, M., & Hussain, R. (2018) An explanation of turnover intention among early-career nursing and allied health professionals working in rural and remote Australia: Findings from a grounded theory study, Rural and Remote Health, 18: 4511. doi: 10.22605/RRH4511 People can follow me/ Attract Connect Stay developments /resources LinkedIn: https://www.linkedin.com/in/dr-cath-cosgrave-23346a85/ YouTube: https://www.youtube.com/@attractconnectstay Facebook: https://www.facebook.com/attractconnectstay/ Instagram: https://www.instagram.com/attractconnectstay/     Find more information about the podcast here: Rural Road to Health You can contact me at: ruralroadtohealth@gmail.com Thank you for listening to the Rural Road to Health!

Dr Kenneth Yakubu completed his PhD at the Faculty of Medicine at the University of New South Wales, Australia, and the co-lead of the George Institute's Ubuntu Initiative for research partnerships in Africa. Dr Yakubu trained as a family physician in Nigeria and practiced there before moving to Australia in 2019. His PhD thesis focused on human-rights based approaches for defining and achieving a sustainable skilled health workforce.   Episode summary: 01.15  Dr Yakubu’s journey into family medicine and experiences with rural health in Nigeria 06.00  Challenges in rural areas of Nigeria 10.50  How does the Nigerian primary care system work? 14.30  How did Dr Yakubu decide to work more in research? 18.50  How did he end up in Australia and the George Institute? 22.00  Health workforce challenges 30.30  How are health workforce issues perceived?  36.15  Health as a human right and how it affects migration 39.30  Positive examples 44.45  Insights into rural health workforce and migration 49.30  George Institute projects   Key insights: Feeling of satisfaction and of connection with the people when working in rural areas. Lack of resources and lack of security of healthcare workers in rural areas.    Hub and spoke arrangement of primary care in Nigeria  - a feeling that rural areas are where you send people you don’t like.   A distance from where decisions are made and the issues on the ground. The health facility felt foreign in the community.  The community had better connections with other systems of care that were more traditional. Not a sense of trust and ownership from the community towards the healthcare facility.     Everyday he was left with issues that left him perplexed, caused frustration but also fed his curiosity.  This led him to research and network with international colleagues.    His experience as a family medicine doctor in Nigeria helped him to successfully apply for his PhD in Australia.     1.8 skilled health workers per 1000 people in Nigeria.  African countries have a large shortfall in the health workforce.     Deconstructing the problem as “our problem”, not continuing with the narrative that high income countries are the bad guy and low middle income countries are the victims.  Taking away you vs them.   How can we define the health workforce issue as a human rights issue?  So that everyone has a stake in it.     Fostering a system of collaborative governance.  Asking questions around sustainability.  Understanding formal and informal rules.     Societal narratives influence how people look at the workforce issue.    The more successful we are in framing it as a human rights issue the more we will be able to find collaborative and equitable ways to solve the issue.   Societal perception of skilled health workers as being arrogant and aloof. Cultural system and value systems - civic engagement at the community level has been absent when looking at the health workforce issue. No political pressure, no social pressure to resolve the health workforce issue. Fragmentation of advocacy and accountability.   Governments can make promises to the population about their right to healthcare without enabling the conditions for that to happen.  Danger of violence towards healthcare workers when they are not able to fulfill these “promises”.     Healthcare workers also have the rights, the right to fair work and remuneration, to live securely and to migrate.    The importance of safety for healthcare workers and how it affects their choice of workplace.    Migration is the last symptom of a faulty health system.  Important to focus on other underpinning issues - repairing the social contract.    Each system has to learn from itself and find a local way for holding itself accountable.   Whole of government approach is needed to address the issues.    Email Dr Yakubu: kyakubu@georgeinstitute.org.au George Institute   Please like and share this episode.  You can send your comments about the podcast to ruralroadtohealth@gmail.com Thank you for listening to the Rural Road to Health!

Welcome back to the Rural Road to Health! Season 2  Episodes will be released on the 10th, 20th and 30th of each month. The first episode will be available on the 20th January.  Feedback form for season 1: https://forms.gle/1XPxUcoiHmVSKRLA8 More information about the podcast: https://theruralroadtohealth.blog/podcast/

The wrap-up episode to the first season of the Rural Road to Health. I will share some insights with you from my journey creating and hosting the podcast and give you a sneak peek to what is in store for 2024. Please take a few minutes to complete the Feedback form.  This will help in shaping future episodes.   Wishing you all the best for the festive season and the New Year! Thank you for listening to the Rural Road to Health!

12th EURIPA Rural Health Forum Summary The forum was held in Romania form the 19th to 22nd of October and brought together over rural family medicine clinicians form accross Europe. Abstract book EURIPA website Please like and share this episode.  You can send your comments about the podcast to ruralroadtohealth@gmail.com If you want to support the work of the podcast please consider donating a Ko-fi Thank you for listening to the Rural Road to Health!

Professor Shelly Nowlan is Chief Nursing and Midwifery Officer for Queensland and the deputy National Rural Health Commissioner for Australia. She has more than 30 years of experience in healthcare and nursing. Episode summary: 01.10  What inspired Shelly to go into rural nursing? 03.00  What does she do in her deputy National Rural Health Commissioner role? 05.30  What is the perception and position of nurses and midwives in Australia? 07.15  What is the scope of practice for nurses in Australia? 09.30  How are education opportunities structured? 11.35  What are the challenges that nurses and midwives face in Australia? 14.40  Are there unique challenges for nurses and midwives globally? 17.20  What is a good way for other networks/organizations to support rural nursing? 19.15  How could we support countries in developing rural nursing training pathways?  21.50  How has Australia developed a supportive environment? 23.50  What are some important ways in which nurses and midwives contribute to health and wellbeing or rural communities?  23.50  How can policy makers support rural nursing and midwifery? 27.45  What has Shelly enjoyed about rural nursing?  29.10  Top three tips for going into rural health careers   Key messages: The importance of knowing what it is like to work and live in rural communities when taking on leadership roles. National Rural and Remote Nursing Generalist Framework - world first, outlining domains that nursing generalists can focus on when developing their skills.  Identifies four domains: culturally safe practice; critical analysis; relationships, partnerships and collaborations; and capability of practice.   Rural nurses and midwives are really valued by their communities and part of the foundation of healthcare in rural areas.  Providing culturally safe care in partnership with families, communities and interdisciplinary teams.   Advanced practice role and generalist practice: primary and secondary assessment, treatment plans, first responders, primary care, acute care,  immunisations, prevention activities, and developing technical skills.  Global world shortages of nurses.  Australia is facing national concerns around the health workforce.  Differences in licensing and credentialing standards across the world.   Real challenges to ensuring there is support from peer networks, standardized approach to mentorship and educational opportunities to develop their careers.  Important to advocate for nursing in rural environments and an investment in education and a nursing generalist program.   Ensuring that there is availability of lifelong learning opportunities.  Investment needed in early career pathways, with students having experiences and placements in rural and remote areas.  Exposure as early as you can, put your hand up for rural experiences. Rural nursing can be generalist but also specialist, you can define a role that works for you. Always be a voice and advocate for the community.     Office of the National Rural Health Commissioner: https://www.health.gov.au/our-work/onrhc National Rural and Remote Nursing Generalist Framework: https://www.health.gov.au/news/release-of-the-national-rural-and-remote-nursing-generalist-framework-2023-2027?language=en Please like and share this episode.  You can send your comments about the podcast to ruralroadtohealth@gmail.com If you want to support the work of the podcast please consider donating a Ko-fi, a link for this can be found in the show notes. Thank you for listening to the Rural Road to Health!

Michelle Rathman is the founder of Impact Communications, Inc. a healthcare strategy and communications company.  Since 1997 she has worked with rural health clinics, state offices of rural health and rural hospitals.  Michelle helps facilitate transformation in healthcare settings across the US.  She is also the host of the Rural Impact Podcast which tries to connect the dots between policy and rural issues. Episode overview: 01.00  Why did Michelle start a communications company and choose to work with rural providers? 05.45  What is healthcare strategy and communications? 07.45  What are the insights Michelle has gained through her work? 11.05  What are the challenges for rural communities in the US and how does communication help? 17.00  What made her decide to start the Rural Impact Podcast? 22.15  What topics will the podcast be covering in the future? 26.00  How do we help communities understand policy?  31.00  How to shape messages for the community and how for policymakers? 35.15 Current projects or recommendations   Key messages:  Rural-academic partnership pilot program which helped to keep a rural hospital open. Any challenge that a healthcare entity faces, the root of it is often communications.   Coumunication is often an afterthought.  Imperative that rural communities understand the value of their healthcare system and that staff members are able to communicate with the people they serve in a way that is meaningful.   Rural health on life-support:  many people never realize the dire situation in rural health in the US.  Rural health is an intricate part of healthcare, if it does not succeed then the US can not succeed in the realm of healthcare.  Workforce shortages - without a pathway, there is no pipeline.  You do not just wake up one morning as a physician and think “I will do rural health”.  Non-clinical positions are also really important, these are usually local people, they need to be aware of these job options.  An increased number of vulnerable rural hospitals are closing their doors.  Finances and reimbursement are challenging.  Policy needs to be at the center of the conversation around rural healthcare.  Over a million children without any health insurance coverage at the moment in the US. Advocacy is one of the most important tools that we have.  All roads to a quality life are paved with policies. Where is policy working?  Showcase the promising practices.  It is important to know who represents you and to understand where that person stands on the issues that are important to you.   Write letters to your representatives, tell them why things are important for your community, it is important for them to see and understand.  Telling your stories is important, invite policymakers to your community. Tell them the solutions that you think are most likely to help with the challenges you face.  If people are not understanding you, then you have to find another way to tell them. It is important to understand who you are talking to.  What information is “need to know" and how will it impact them.  For policymakers: share a story then give data or a stats sheet with information about what it is, how it is going to be used and how it will benefit their constituents.     “The Providers” - a documentary 100% community: ensuring 10 vital services for surviving and thriving (book) - related to work in New Mexico.    Michelle Rathman: https://www.michellerathman.com/ The Rural Impact Podcast: https://www.myimpact.academy/rural-impact-podcast    Please like and share this episode.  You can send your comments about the podcast to ruralroadtohealth@gmail.com If you want to support the work of the podcast please consider donating a Ko-fi.  Thank you for listening to the Rural Road to Health!

Welcome to Rural Policy Bites. In this episode I will reflect on two events that I have attended in the past few weeks: High-level Rural Policy Forum, Siguenza, Spain Institute for Health Equity Conference, Birmingham, UK   For more information: Rural Pact: https://ruralpact.rural-vision.europa.eu/index_en Rural Observatory: https://observatory.rural-vision.europa.eu/?lng=en&ctx=RUROBS Recording available form the forum: https://www.youtube.com/watch?v=P9NfBGkucB4 Institute for Health Equity: https://healthequitynetwork.co.uk Recording available from the conference: https://www.youtube.com/watch?v=rnxkCOWyaDU   Like and share this episode.  You can also support the podcast by buying a Ko-fi. If you want to contact me or share some feedback you can do this at theruralroadtohealth.blog or at ruralroadtohealth@gmail.com Thank you for listening to the Rural Road to Health!

Daniel Dawes is a lawyer, author, scholar, educator and leader in health equity and health reform.  His research focuses on the drivers of health inequities among under-resourced, vulnerable and marginalized communities, he has pioneered a new approach to examining inequities - the political determinants of health.  Daniel was instrumental in shaping the Affordable Care Act in the US (also known as Obama Care) and chaired the National Working Group on Health Disparities and Health Reform.  Episode summary: 01.15  How he became involved in work on the political determinants of health 07.45  What are the political determinants of health? 18.30  How do the political determinant of health impact rural communities in the US?   26.10  How important is it for people to understand the political determinant of health? 32.15  Is the political will there to address the political determinants of health? 36.15  How can advocacy groups work together with policy makers to address the political determinants of health? 42.05  What kind of people become community leaders?  44.05  Will the political determinants be addressed in the future?    Key messages: We have only scratched the surface when it comes to the determinants and drivers of inequalities.  Socially derived inequities, not private choices.  For each social condition or social determinant of health there was a preceding political action or inaction, or policy action or inaction, that led to the social condition.  Political determinants of health involve the systematic process of structuring relationships, distributing resources and administering power.  They operate simultaneously and influence one another to shape opportunities that either advance or hinder health equity. Having sidewalks in one community and not in another is a political decision, the evidence shows that having sidewalks makes communities more walkable and encourages physical activity.   How does the law structure relationships among communities? How are resources distributed?  The administration of power is the most contentious. Are people allowed to be involved in the political process?  Lack of voting in many rural communities and communities of color means that the decision makers are not representative of those communities.  Continual strategic process that never ends, people think that when a policy is passed and implemented then it is done, that is not the case, it requires constant monitoring and participation from the electorate.  Lower voting participation in minoritized groups.   It is important for people to be aware of the political determinants of health, they are the invisible hand that has been operating behind the scenes affecting all aspects of life.  Advocacy is at the heart of the movement to advance health equity.  Important to understand the history, the politics, the policies and the tools that have been used and can be used in their advocacy movements.  It is built on relationships and is a continuous process.   You have to build relationships - within communities, with policy makers and with non traditional partners. Building coalitions to address particular issues. Work with policy makers, find the evidence and do the research, then find the champions that can get your agenda through. Introspection to determine personal and organizational strengths and weaknesses.  Harness the power of collaboration.   In order to be an effective leader you first have to care enough, know enough, have the courage to do enough and then persevere until the job is done.    Resources: Videos to help you understand the political determinants of health: Jessica’s story https://www.youtube.com/watch?v=G54x6Y-aJvE Allegory of the orchard -    https://www.youtube.com/watch?v=mux1c73fJ78 https://www.youtube.com/watch?v=8gTbPog_J9s  Meharry Global Health Equity Institute: https://home.mmc.edu/meharry-to-launch-new-global-health-equity-institute-led-by-health-policy-expert-daniel-e-dawes/   Thank you for listening to the Rural Road to Health, contact me via ruralroadtohealth@gmail.com Support the podcast by buying a Ko-fi

Dr John Pawlovic, he is the Chair in Rural health with the University of British Columbia and a family doctor who has dedicated his career to improving the health of rural, remote and Indigenous communities.  We will talk about an innovative project -the Real-Time Virtual Support network which aims to address inequitable access and barriers to healthcare faced by rural, remote and indigenous communities.  Dr Pawlovic is the virtual health lead for the Rural CoordinationCentre of BC which heads the RTVS program.   Episode summary: 01.45  RTVS - how it started  03.50  Development of the Edge of Care documentary 05.15 How did he decide to practice rural medicine? 06.45 Where does he work now? 09.15  I give a brief overview of the RTVS program and reflect on the interview discussion   Key messages: Idea started as a way to support remote and indigenous communities.  Outcome of decades of work in the virtual health space. Supporting equitable access to high quality care. Two arms of the program, one faces patients and the other providers. Bringing together technology with on the ground care - hybrid care.    Resources: Edge of Care Documentary: https://rccbc.ca/initiatives/rtvs/edge-of-care/ RTVS website: https://rccbc.ca/initiatives/rtvs/ Article published about he program: https://journals.sagepub.com/doi/full/10.1177/08404704231183177   Thank you for listening to the Rural Road to Health, contact me via ruralroadtohealth@gmail.com Support the podcast by buying a Ko-fi