Changing landscapes, changing lives: is it time for transformational health system change?

Professor John Wakerman1

1Associate Dean, Flinders University Northern Territory


In 1994, the first National Rural Health Strategy called for the development of “…innovative models of rural service delivery…to meet the diverse health care needs of rural communities.” Twenty four years later there continue to be calls for “innovative solutions.” But over this period we have developed a substantial body of knowledge about what service models work in different contexts and why they work. Is it time to implement what we know and is this sufficient to achieve the transformational change we envisaged in 1994?


Professor John Wakerman is the Associate Dean Flinders NT. He has worked for the past three decades as a remote GP, educator and remote and rural health services researcher.

Changing landscapes, Changing Lives: Time for the Allied Health Rural Generalists Pathway

Julie Hulcombe1

1Chief Allied Health Officer, Queensland Health


The concept of an Allied Health (AH) rural generalist is not new, but has not been well described nor has there been a formal program associated with AH rural generalism.  There are continuing challenges in attraction and retention of staff in rural and remote locations, and a maldistribution of workforce with a concentration in metropolitan areas.  The time is right to change landscapes, change lives in rural services, communities and support for rural and remote clinicians by implementing the Allied Health Rural Generalists Pathway (AHRGP).

This presentation will outline

  • why the AH rural and remote generalist program should be implemented,
  • how the program was developed,
  • what is an AH rural generalist (and what it isn’t),
  • the components of the program and the implementation to date,
  • a road map for what has to happen next to make the program sustainable.

The landscape is changing which may further support implementation of the AHRGP. This includes the appointment of the Rural Health Commissioner, improved technology, expansion of the University Departments of Rural Health to include Allied Health support and the primary health networks and other commissioning agencies.   Partnerships between the commonwealth government, across the jurisdictional public sector, non-government agencies, community controlled services, the private sector, SARRAH, workforce agencies and education providers are critical to success.


Julie Hulcombe is the Chief Allied Health Officer, Department of Health, Queensland.   Julie is an Accredited Practising Dietitian (APD). She has had an extensive career with Qld Health working in clinical Dietetics at both regional and tertiary hospitals and management roles in Dietetics, Allied Health and Health Planning. Julie is an Adjunct Associate Professor with QUT. She is a past President of the Dietetic Association of Australia (DAA), and has been the Chair of the DAA Dietetic Credentialing Council and the National Allied Health Advisors Committee.  In her present position Julie has led initiatives in workforce models of care, clinical education and research.

Every eye is an eye, but every journey is different: insight into The Fred Hollows Foundation’s culturally responsive eye care models

Jaki Adams-Barton1

Regional Associate Director – Australasia, The Fred Hollows Foundation


For Aboriginal and Torres Strait Islander people, there is a distinct gap between the need for eye health care services and access to those services. Each patient’s journey to screening and treatment for eye conditions is individual and distinctive, within a highly complex patient pathway. The Fred Hollows Foundation works to build culturally responsive models of eye care that put the patient and their individual needs at the centre. The patient journey should be seamless and fully integrated, allowing the patient to move from one level of care to another within a reasonable timeframe. By taking a health system strengthening approach and championing Aboriginal and Torres Strait Islander leadership, The Fred Hollows Foundation seeks to bridge the gap between access and need. This is to ensure that Aboriginal and Torres Strait Islander people can access the right care, at the right time, by the right team, in the right place. Leading ophthalmologist and human rights campaigner Professor Fred Hollows called for Aboriginal and Torres Strait Islander control and ownership of health services in the 1970s when he led the National Trachoma and Eye Health Program. Over 40 years later, The Foundation continues his legacy in partnership with a range of organisations to help create models of eye care that are culturally responsive and safe for Aboriginal and Torres Strait Islander people.


Jaki was born and raised in Darwin and is of both Aboriginal and Torres Strait Islander descent, with ancestral links to the Yadhaigana and Wuthathi people of Cape York Peninsula in Queensland, traditional family ties with the Gurindji people of Central Western Northern Territory and extended family relationships with the people of the Torres Straits and Warlpiri (Yuendumu NT). Jaki is from a large extended family and is very proud to be a part of such a supportive and loving unit. Jaki sees balancing work and home life as her major challenge but one that she makes every effort to succeed at. Jaki returned home to Darwin in 2008 after spending 11 years in Brisbane, to reconnect with her family and enjoy the relaxed and culturally diverse environment that Darwin and the Northern Territory has to offer.

Jaki’s career includes Hospitality; Secondary Teaching; and, over 18 years in the Australian Public Service (APS) and a short stint in the NT Public Service. Jaki’s experience as a public servant started as a Graduate Administrative Assistant with The Aboriginal and Torres Strait Islander Commission (ATSIC), progressing across a variety of Aboriginal and Torres Strait Islander Health and Aged Care programs, and then 8 years in the Australian Defence (security) portfolio. Working her way, across the APS, Queensland and the NT, to the position of NT Director of the Office for Aboriginal and Torres Strait Islander Health (OATSIH) in the Department of Health and Ageing (DoHA) in 2008. Jaki joined The Fred Hollows Foundation’s Indigenous Australia Program in early 2012 and was soon promoted to the Manager’s position in January 2013.

Jaki’s achievements in this time include refocusing the programming to align with The Foundation’s global eye health outcomes through developing capacity and confidence of the team (and partners) to significantly influence the sector to consider eye health beyond the clinical aspects and in line with patient pathways, cultural competence, health literacy, service level coordination and system strengthening. Through her commitment, passion and determination Jaki has proven to be an invaluable contributor to improving eye care access for Aboriginal and Torres Strait Islander people. Jaki has recently been promoted to Regional Associate Director – Australasia in recognition of the work done for The Foundation and the sector in Australia, and in the interest of sharing this knowledge and her professional strengths to build a new region for The Foundation. The Region includes programming in Australia (through the Indigenous Australia Program), the Pacific (Trachoma elimination specifically) and Timor Leste.

Jaki has held many leadership roles, including Chair of Vision 2020 Australia’s Aboriginal and Torres Strait Islander Committee, a Vision 2020 Australia Board Member and as The Foundation’s key representative on the national Close the Gap Steering Committee since 2012.

Jaki has a personal and professional commitment to do whatever she can to improve the health and wellbeing of Aboriginal and Torres Strait Islander people.

Jaki states that

“……being able to have direct impact on and positively contribute to programs (and broader discussions) that address ending avoidable blindness and improvements in Aboriginal and Torres Strait Islander health is an inspiring and an honourable position to be in”.

“Being welcomed into The Fred Hollows family and charged with significant responsibility (to keep Fred’s legacy alive) in a complex and diverse environment, is both challenging and rewarding, and keeps me engaged and motivated to make a difference everyday”

National Rural Generalist Pathway “application of pathway principles for Allied Health professionals”

Professor Paul Worely

Rural Health Commissioner



Rural communities require a breadth of high quality services to be delivered locally. Innovative ways to overcome the diseconomies of scale are required, and up to now have proven to be elusive in the Allied Health space, particularly because of workforce maldistributions. Is it possible for Allied Health professions to learn from the principles being applied to the National Rural Generalist Pathway in medicine? Can we also learn from jurisdiction based initiatives? Could Allied Health professionals lead the way in some areas? The communities of rural and remote Australia need answers to these questions.

NDIS Panel Session

Rob Curry, President, Services for Australian Rural and Remote Allied Health (SARRAH)


  • Edward Johnson, Speech Therapist, Marathon Health
  • Jeff Cook, CEO Lanyhapuy, Homelands Health Service
  • Donna-Maree Towney, Project Officer, Indigenous Allied Health Australia
  • Stephanie Gunn, General Manager, Partners in the Community

The NDIS panel session will bring together 4 different perspectives on applications of the NDIS program in rural and remote Australia.  We will hear from the NDIA about work the Agency is undertaking to ensure people in rural and remote Australia get fair access to quality services.  We will get a view from a remote Aboriginal community in the NT about the benefits and challenges presented by the NDIS for people with disabilities in a remote setting.  Findings and recommendations from a project looking at culturally responsive disability service provision in rural and remote Australia will be offered up.  And finally, and importantly, we will gain insights to community and participant views of the NDIS and disability services from western NSW.  The panel session will provide a forum for delegates to explore these different domains, and to then compare and contrast the different challenges and opportunities for allied health and disability services in rural Australia under the new arrangements.

‘Doing what suits’: Sharing stories of culturally responsive practice in research

Amery, R1. and Wunungmurra, J.G2.

1Charles Darwin University, Darwin, Australia

2MJD Foundation, Darwin, Australia 


The cultural and linguistic diversity of Australia is one of our greatest assets. It will also be one of the biggest drivers of change for health professionals over the coming years. Providing allied health services that are responsive and appropriate to our increasingly diverse and changing population is a challenge we must overcome in order to provide effective services to all Australians.

In 2018, more than 300 different languages are spoken by Australians. Nearly 50% of Australians identify as first or second-generation migrants, and more than 25% of Australians speak more than one language. A significant part of our multicultural landscape is the rich and diverse cultures and languages of nearly 650,000 first Australians. English or Aboriginal English is a first language for many Aboriginal and Torres Strait Islander people who live in urban or rural settings in Australia. However, many others living in more remote regions of Australia grow up speaking one or several Aboriginal or Torres Strait Islander languages and acquire English as a last rather than a first language. Alongside linguistic difference comes different worldviews, and different ways of conceptualising meaning and transmitting knowledge.

Appropriately, cultural and linguistic differences in conceptualising and transmitting knowledge are also stimulating changes in the research landscape. Students and early career researchers face diverse and emerging methodologies, participatory research practices and partnerships that aim to improve culturally responsive research practice, particularly with Aboriginal and Torres strait Islander communities. But what does all of this look like in situ? And what relevance does it have for our clinical practice?

For the last two years, Rebecca (speech pathologist and PhD student) and Julie (Yolŋu Health and Community Worker and Co-Researcher) have worked together on a PhD communication research project with Yolŋu families from northeast Arnhem Land living with Machado-Joseph Disease. Together they will share some of their early experiences and learnings of working together, through language and worldview differences, and putting principles of culturally responsive research into practice.


Rebecca Amery
PhD Student | Speech Pathologist, Charles Sturt University

Rebecca Amery is a doctoral Candidate at Charles Darwin University (CDU). Her research aims to build understanding about communication difficulties for Yolŋu living with Machado Joseph Disease and their families, and to improve communication opportunities through the development and use of bilingual Augmentative and Alternative Communication (AAC) systems.

Rebecca grew up in the Northern Territory, in Yirrkala, Arnhem Land and in Darwin. She completed a Bachelor of Speech Pathology at the University of Newcastle with Honours (Class I) in 2011. Rebecca started her PhD in partnership with the MJD Foundation in 2016 and is also enrolled in a Graduate Certificate of Yolŋu Studies at CDU.

Rebecca has a personal and professional interest in working in intercultural partnerships in varied community contexts, using AAC to improve communication access for people who experience communication vulnerability. Rebecca has practiced as a speech pathologist in early intervention, schools and adult contexts with culturally and linguistically diverse families in Darwin, Melbourne, Vietnam and Indonesia. Her work often involves the use of interpreters, cultural brokers and partnering with local staff to deliver speech pathology services, facilitate workshops and develop communication resources in languages other than English.


Julie Gungunbuy Wunungmurra
Yolgnu researcher

Julie Gungunbuy Wunungmurra has worked for the MJD Foundation as an Aboriginal Health Community Worker since 2013. Julie is the primary contact and support person for Yolŋu clients with MJD and their families in Darwin, Galiwin’ku and Yirrkala. Julie provides support to MJD Foundation community services, research and education programs and projects, and provides cultural advice and support, as well as translation and interpreter support with research, medical and genetic concepts. She has been the primary Yolŋu researcher for the Communication PhD project and is also involved in genetics and sleep research studies with the MJD Foundation.

Caring for the Carers: Taking Burn-out Prevention Seriously

Annmaree Wilson1

1Senior Psychologist, CranaPlus Bush Support Services


The purpose of this presentation is to highlight the very serious problem of burn-out in the remote health workforce and to promote the prioritising of self-care as a central, rather than secondary, activity to service provision. Research is showing that working as a nurse is a risk factor in developing symptoms of stress. Given that there is a growing body of psychological research that indicates that psychological resilience to stress can be achieved, it is important that health services become pro-active in building this capacity in their workforce.

One of the frequent features of the remote health workplace are nursing shortages and high staff turn-over. All health professionals working in remote settings, are exposed consistently to potentially traumatic and stressful situations. Experiencing high levels of stress, without adequate coping strategies, leads to burn-out.  When burn-out goes unaddressed or inappropriate coping strategies are implemented, the best possible scenario is staff leaving their positions for less stressful ones. At worst, burn-out leads to serious mental health issues such as depression, anxiety and depersonalisation. In both situations many lives are affected, patient care is compromised and the cost to society is very high.

This presentation will explore the literature that identifies the benefits of self -care capacity building. It will highlight the way Bush Support Services has incorporated this research into its’ self-care workshops by promoting personal well-being and adaptive coping.  The presentation will particularly address the how Mindfulness training, addressing relationships, cognitive issues, exercise, diet and creativity are necessary and essential skills to deal with the psychological demands of remote health work.


Dr Annmaree Wilson is the Senior Clinical Psychologist for Cranaplus Bush Support Services. She completed her undergraduate and post graduate degrees at the University of New South Wales. She completed her PhD from the University of New England in 2002. Annmaree has worked extensively as a Clinical Psychologist in rural and remote areas of New South Wales, particularly in the area of child, adolescent and family. She has a special interest in Positive Psychology and the use of creativity, such as art, singing and music, as  means of building psychological resilience.

Flying Doctor Research in remote Australia: what’s the data telling us

Dr Fergus Gardiner1

1Royal Flying Doctor Service of Australia


As celebrations of our 90th year of operation wind down, it is pertinent that the Royal Flying Doctor Service (RFDS) continue to look to the future, to ensure that our services remain competitive and efficient, optimally targeted and designed to meet the needs of a changing population in remote and rural Australia. The Australian population is estimated to be 29.4 million by the year 2028 with a percentage growth of 1.4% from the previous year. Chronic diseases are estimated to increase from 11.8 to 13.8 million Australians living with at least one chronic disease between 2018 and 2028, with cancer, mental health, and cardiovascular disease prominent. Neurological disease Disability-Adjusted Life Year (DALY) increased by 3.7% per year from 2003 through to 2011, indicating that without further intervention this prevalence will continue to grow until 2028. Pathology, imaging, and pharmaceuticals is expected to reach 6.6, 1.3, 9.3 service episodes per-patient per-year, respectively in 2028. This equals 17.2 services accessed per patient per year in 2027-2028 as compared to 13.3 in 2007-2008. This increase is significant (p=<0.01), and is believed to reflect growing chronic disease rates. When comparing areas of low to the areas of high medical service supply there are a significant difference in provision, with the majority (p=<0.01) of the low supply being in rural and remote areas. Furthermore, the majority of clinical provision per 100,000 people are predicted to be located in metropolitan areas by the year 2028, with significant (p=<0.05) workforce shortages in rural and remote areas as reflective of recommended benchmarks.  There are, and will continue to be, significantly lower services in rural and remote as compared to metropolitan areas, and that workforce provision is and will also continue to be significantly lower than metropolitan areas per 100,000 population. This is concerning as the rates of DALY per 1000 population related to cancer, cardiovascular disease, mental health, are expected to continue to be significantly higher in rural and remote as compared to metropolitan areas. Consequently, there will need to be: 1) health prevention to halt growth in cancer, mental health, cardiovascular disease; 2) extra primary treatment to respond to chronic disease growth; 3) extra health staff incentives for going to the bush. The RFDS will be in high demand throughout the next ten years, with expected growth of service provision in primary and retrieval medicine, and increased outreach program provision involving specialists, Allied Health, mental health, dental, and telehealth to rural and remote areas.


Fergus Gardiner has recently completed a PhD (medicine) specialising in chronic kidney disease management. Fergus has been the lead author on research projects, involving emergency and military medicine, rural and remote healthcare, pathology, and obstetrics and gynecology.  Prior to commencing with the Flying Doctor, Fergus served in the Australian Defense Force before employment in large teaching hospitals and the Department of Health.  Fergus is a visiting academic at the Australian National University Medical School, were he conducts epidemiology and clinical research. Furthermore, he is a consultant associated with applications to the Federal Government’s Medical Services Advisory Committee, in the field of chronic disease management.


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