What Are Some of the Barriers to Overcome
What are some of the barriers to overcome in the rural health care system and how do they affect the quality of physiotherapy care available in rural Australia? Introduction This paper is aimed at examining the barriers in the rural regions that contribute towards a poor physiotherapy care and exploring some strategies to work towards a better physiotherapy care in those regions. With higher mortality rates and lower life expectancy, rural health has been a major concern for the Australian Government and having rural health catch up with the city counterparts is a vision that the government has been working on achieving (Williams et al. 007, p. 380).
Physiotherapists are also concerned by this since they contribute to the WHO definition of health by working with people with disabilities through active rehabilitation programs, education, health promotion initiatives, advocacy and strategies to remove barriers, and by fostering increased participation in activities. However, many hurdles stand in the way of this dream coming true and these include cultural, structural, historical and critical factors. Historical Factors Australia’s rural economies have always been running on agriculture.
For a while now, their economy has been going downhill and this has had consequences on the health care available in these communities. Back in the days, with a stable economy, the inhabitants did not have to travel very far to get a job, earn money and have a respectable living standard. However, events such as globalisation and climate change have had significant consequences on agriculture. There were changes in government subsidies, transport costs, sale of farms, and relocation of farmers off the land (Mahoney et al. 2001, p. 107). The income provided by this industry was no longer sufficient enough for the whole area to survive.
In addition to that, with the increased use of machines in such industries, inhabitants found themselves unemployed and had to move to the cities for jobs (Hughes 2009, p. 200). Hence, this resulted in a series of events leading to downgrading of schools, loss of health care workers, closure of banks, hospitals and loss of services such as water and electricity (Mahoney et al. 2001, p. 107). Thus, for those chose to stay back, they did not have adequate health care services and providers to have access to better primary health care such physiotherapy care.
Structural Factors This section looks at how some specific forms of social organisations affects rural lives and consequently the quality of physiotherapy care available to the rural communities. Mahoney et al. (2001, p. 106) found that one of the significant structural changes was the relocation of Home and Community Care (HACC) services to the nearest town, which was one hour away and it lead to having a day-to-day support to the elderly moving to an outside location, the potential loss of a personal service and local knowledge of residents requiring services.
With the lack of proper infrastructures available for good health care quality, the health care workers move to other towns and the rural communities are left with just one or two doctors. During his study, Mahoney et al. (2001, p. 106) noted that one of the rural communities being studied used to have only one doctor before and he would be on call day and night, seven days a week. If he was away on weekends, inhabitants requiring medical assistance had no other choice than travel long distances to get help.
The centralization of local government services away from rural communities leads to the loss of a significant amount of jobs, loss of families, businesses, contributions within the community and the remaining inhabitants felt a bigger burden on their shoulders (Mahoney 2001, p. 106). With the loss of all these services, only second rate services were available to the residents, who would stop using them and move to places where better services and standard of living were available (Mahoney et al. 2001, p. 107).
Germov (2009, p. 18) states that the social production and distribution of health and illness highlights that many illnesses are socially produced, such as from exposure to hazardous work practices, which is often the case in the rural communities. Agriculture represents a great aspect of rural life as well as one of the highest risk groups for occupational injury and disease (Welch, 2000).
Farms in the rural communities are not only workplaces but are also the homes for a great majority of the population. Hughes (2009, p. 04) believes that the rates of farm injury are quite alarming with tractors, motorcycles, animals, tools and machinery being major causes of these injuries amongst the male population. Welch (2000) also found that the transport injury rates were significantly higher in the rural and remote areas compared to those in the city. This is further supported by an NHRMC report which states that it is “almost certainly due to a combination of factors including exposure to travel, patterns of alcohol use, conditions of motor vehicles, seat belt use, and access to emergency medical services.
It may also be due to less deterrents in the form of lower levels of policing on country roads to check on speeding and drink driving” (Welch. 2000). Children living on a farm are also at risk, with chemicals and machinery lying all around the place and inadequate adult supervision (Hughes 2009, p. 205). Helmets should be provided and used as stated by the Australian Safety Standards and chemicals should be stored in places where children would not be able to have access, to help reduce these risks (Hughes 2009, p. 05). On top of the high injury risks in the rural communities, there exists the problem of adequate access to transport and poor road quality.
This restricts the access the few health services available and although the Isolated Travel Allowance partly assists by compensating the partial costs of using a service which is not found locally, the refund provided does not come close to covering the true cost of the time taken off work and the related social expenses (Welch, 2000). Germov (2009, p. 8) states that the social organisation of health care concerns the way a particular society organises, funds, and utilises its health services. In his study, Mahoney (200, p. 106) found that in one of the rural communities, Hopetoun, one public hospital with its own emergency care facilities was created by the merging of three hospitals within the regions.
The inhabitants voted to have the hospital changed from being a private ‘bush nursing’ hospital to a public hospital. Cultural Factors The social construction of health and illness is defined by Germov (2009, p. 8) to be the varying definitions of health and illness between cultures and also the changing definitions over time, whereby what is considered to be a disease in one culture or time period may be considered normal and healthy elsewhere and at other times. Germov (2009, p. 18) is of the opinion that notions of health and illness are not necessarily objective facts, but can be social constructions that reflect the culture, politics, and morality of a particular society at a given point in time.
This can be easily seen in the rural communities, where health is described as an absence of disease and hence the whole focus of the health care services available in the rural regions is on curative treatment rather than primary care and health promotion (Welch, 2000). According to Welch (2000), the rural culture is such that well-being is often related to productivity and sickness and pain are deemphasised, while importance is attached to being able to carry out daily tasks.
People in the rural regions respond to illness depending upon the effects that it has on productivity and they often ignore the illness or tolerate despite discomfort or risk (Welch, 2000). According to Hughes (2009, p. 198), the indigenous people represent a significant portion of the rural population and they are known to have a life expectancy of 20 and 15 years less than non-Aboriginal Australians. Hence, the Indigenous health is a priority.
However, primary health care workers find it challenging to work closely with the Indigenous population due to poor communication and cultural differences (Andrews et al. 002, p. 197). This situation is not restricted to just the Indigenous patients but also the Aboriginal health workers since general practitioners are usually uninformed of their availability and role and are hesitant about how to contact or work with them (Andrews et al. 2002, p. 197). One way to ensure access to good quality physiotherapy care is to have physiotherapists and their staffs undertake Aboriginal cultural awareness training (Andrews et al. 2002, p. 198). This can be one sure step towards bridging the gap and providing good healthcare to the Indigenous population.
Another aspect of living in a rural community is while you get to know all your neighbours quite well, your neighbours also get to know all about you and your life. This is further supported by Hughes (2009, p. 207), who found that practitioners have a strong sense of ‘being known’ and lacing privacy. This can also be true in the other way, in the sense that inhabitants are reluctant to go to the local medical practitioner due to the lack of privacy in such a small environment, where everyone gets to know everything.
Hughes (2009, p. 201) is also of the opinion that closeness the inhabitants have with each other in the rural communities can be a barrier to good healthcare services. She believes that this can exert a great influence on the decision making and judgement skills of a healthcare worker, depending on the relationship the latter has with his/her patients. Critical Factors One of the issues for physiotherapists while working in the rural communities is findings programs which enable them to get better training and increase their skills.
The Australian Physiotherapy Association Rural e-Resource has a list of programs available to support clinicians in the rural workplace, including Allied Health Rural and Remote Training and Support Program, which provides CPD for rural and remote clinicians, University of Tasmania Department of Rural Health, which provides a calendar of training programs relevant to rural health, and the Independent Living Centre WA, which provides videoconferencing for clinical and educational events for WA for both the private and public sector.
Rural health is also affected by the lack of workforce recruitment and being aware of this issue, the Australian Government has come up with some initiatives to overcome this (Hughes 2009, p. 206-207). These initiatives include Rural Undergraduate Support and Coordination (RUSC) which consists of a greater intake of students from the rural areas and establishment support for rural placements, Australian Government Remote and Rural Nursing Scholarships which offer scholarships for rural and remote nurses to undertake postgraduate study and short courses (Hughes 2009, p. 06-207), and The Australian Government has also put an outcome strategy (Outcome 6) which encourages people outside the rural community to take up a career practising in the rural regions.
This strategy is based on the principle ‘the more remote you go, the greater the reward’ (Australian Government, Department of Health and Ageing, 2009). Conclusion Although most of the barriers standing in the way of better rural health have been identified, not a lot of the strategies undertaken have made even a significant dent in the issue and there still remains an enormous amount of work to be done in this area.
Most of the studies and literature found were focusing on the rural health care system, rather than just physiotherapy. However, the initiatives and strategies employed for the general rural health care system would be of some use to providing a good quality physiotherapy care in the rural communities, since the barriers still remain the same. However, more studies focusing on physiotherapy and rural health should be conducted so as to create awareness amongst the Australian physiotherapists’ community and also help the physiotherapist already working in the rural communities.