Frontier Vol 8 Edition 1 2023

A M S A R U R A L H E A L T H
FR NTIER
VOLUME 8 EDITION 1 2023

AMSA RURAL HEALTH | FRONTIER
C O N T E N T S
2
Letter from the
Editors
3
Meet the
Subcommittee
5
Letter from the
Chair
7
Rural Psychiatry: a Passion for
People - William Darmawan
9
Changing Lives: Psychiatry in the
Red Centre - Madelyn Deigan
15
Rural Doctors’ Network ‘Go Rural’
Trip Reflections: "Why I went rural
and why I think others should
too." - Charlie Aitken
19
Bridging the Rural Divide:
Ensuring Equitable Access to
Sexual and Reproductive Health in
Post-COVID Rural Australia - Lois
Segun-Beloved
23
When in Roma - AMSA/RANZCP
Scholarship Recipient – Saleha
Khan
27
From Remote Island to Regional
NSW: Inspiring a Refugee Lawyer
to Pursue a Career in Healthcare -
Rebecca George
31
A Reflection of Global Health in
Rural Australia - Abbey Isaac
35
Beyond Red Dirt Roads:
Discovering the Hidden Gems of
Rural Healthcare - Dr Nikitha
Kramadhari
39
My Journey in Rural Australia - Dr
Sugamya Mallawathantri
42
The Pandemic President: Dr Sarah
Chalmers - Andrew Cramb
47
The Rich Tapestry of Rural
Healthcare: A Gateway to Diverse
Experiences
Cover Photo:
'Bonfire with Notre Dame
Medical Students,
by Vivien Wu
F R O N T I E R ! | A M S A R U R A L H E A L T H | 1

FROM THE EDITORS
Hello dear readers!
Thank you for picking up this virtual edition of Frontier!
AMSA Rural Health’s magazine.
Our aim for this edition, ‘Reflections on Rural Health’, is to
weave together stories from all the disciplines of health.
Throughout these pages, you’ll find articles from rurally
based medical students, doctors, pharmacists, nurses and
more, sharing their reflections on what rural health means
to them.
We’d like to thank our own little AMSA Rural family, in
particular our Frontier Editorial team, who have dedicated
the last few months to collating pieces and creating the
beautiful pages that make up Edition 1.
Although rural medicine is sometimes approached with
apprehension, we hope these stories illustrate the
powerful nature of community and connection that is
found nowhere else. No matter where in rural Australia
your medical career takes you, the individuality and
diversity of rural medicine will strengthen, challenge and
change you for the better.
We hope that you find something within these pages that
inspires!
Anita and Ini
2023 AMSA Rural Publications Officers
F R O N T I E R ! | A M S A R U R A L H E A L T H | 2

Anita Date, Monash University, Year 5
Welcome back to another edition of ‘Frontier!’ We have packed
this edition full of stories to inspire you no matter where you are
on your journey in rural health.
Despite growing up in suburban Melbourne, I spent my time as
a medical student immersed in diverse rural and regional
medical settings throughout Victoria, from remote towns of
8,000, to bustling rural cities of 160,000. I can testify that their
unique complexities, relationships and communities mean no
two rural towns are alike. I am now proud to call regional
Victoria home, and might see you around Bendigo Health in
2024!
Wherever you are on your journey, I hope you can always
continue exploring new “Frontiers”!
Ini Segun-Beloved, Western Sydney University, Year 2
Hey there! So excited that you’ve decided to have a read of the
2023 Frontier! magazine. Growing up in a rural area and moving
to the city made me realise the great disparity there is in the
health field.
My passion for rural health grows stronger every day and I hope
the theme “Reflections on Rural Health” helps grow your own
passion or even trigger an interest in rural health. The medical
field is a vast and ever-changing one and I aim to one day make
a difference.
Enjoy this edition of Frontier magazine and hopefully you’ll be
just as excited as I am for the next edition!
F R O N T I E R ! | A M S A R U R A L H E A L T H | 3

Kyra Postlethwaite, Monash University, Year 5
Hiya! After growing up mostly in the regional Victorian city of
Ballarat, with close family connections to the Wimmera and Mallee
regions of rural Victoria, I have always appreciated the joys and
challenges of life in the country.
Now I have also completed - and loved - my medical school
placements in Victoria's North-West, and I believe the country has
so much to offer from a lifestyle and a career perspective. I can’t
wait to keep exploring the impact I can have on rural health once I
graduate!
Having mostly been the dancing and singing type of creative
throughout my life, the magazine scene is new territory for me, and
being part of the team bringing you this edition of ‘Frontier!’ has
been an honour. I hope you enjoy it!
Rashmi Perera, Western Sydney University, Year 2
Hi there!
I grew up in the rural town of Dubbo, enjoying the simple beauty of
rural life. These days, I'm still adjusting to the bustling rhythm of
Sydney.
I hold countless memories from my time in rural Australia,
surrounded by the beauty of rural landscapes and the warmth of our
tight-knit community. Living in the country opened my eyes to the
stark healthcare disparities rural areas face. Through firsthand
experience, I understand the urgent need for increased funding and
a robust healthcare workforce in rural hospitals.
I'm thrilled to have played a part in creating this Frontier edition,
where we dive deep into the fascinating world of rural health. Stick
around, and you'll discover that there's so much more to it than
meets the eye!
Deepthi Kramadhari, Western Sydney University, Year 2
Although I grew up in metropolitan Sydney, my parents have
always been very enthusiastic about exploring the bush, so
I’ve grown up spending my summer on family road trips
travelling through rural/regional NSW and QLD. For those who
may lack firsthand experiences in rural communities or are
just curious about the opportunities within rural medicine,
reading the Frontier magazine is an excellent way to delve into
these questions. I became a member of the Frontier team
because the magazine is exactly what I needed as someone
who is just starting to consider future rural practice. I hope
this edition has the same impact on you!
F R O N T I E R ! | A M S A R U R A L H E A L T H | 4

Hi there!
Welcome to ‘Frontier!’, a place where we
celebrate the vibrancy, excitement and
challenge that is rural health. In this edition, the
amazing Frontier! team has worked endlessly
to present to you Reflections on Rural Health.
Sometimes the business of life and the
whirlwind of placement means many of us
don't get the chance to slow down and see how
far we have come. It would be amiss not to
acknowledge that rural medicine has its tests,
but with them come the triumphs and
fulfilment of studying, working and living in an
environment bursting with a sense of
community and joy. It is in these moments of
reflection that we continue to find the
inspiration and motivation that propels us
further on our rural health journey.
At our wonderful retreat held on Phillip Island in
Victoria at the start of this year, the AMSA
Rural Health team met in person to enjoy the
coast’s sparkling blue waters, compete in a
paper aeroplane competition, bond over a
game of Organ Attack, and also to reflect on
the reasons we are drawn towards rural health.
These reflections form the foundation of our
goals in promoting the myriad pathways into
rural medicine.
Keep an eye on our social media (Facebook
and Instagram: @amsarural) for upcoming
projects, rural stories and experiences, and our
new segment ‘Getting Real, Getting Rural’,
where we share interesting rural related
articles. We are also planning to host a webinar
about specialty training pathways in rural areas
because, after all, there really is a place in rural
health for everyone, including our future
specialists! Later this year, we will be visiting
rural highschools, as part of our project
‘Stepping into Med’, to speak with students
about potential careers in medicine.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 5

Reading this edition of ‘Frontier!’ has
encouraged me to reflect on my own feelings
about rural health. For me, medicine in rural
Australia is about adventure, having the
courage to challenge myself, serving strong
and supportive communities, beautiful wildlife,
and exploring medicine in creative ways (such
as in retrieval medicine!). I am driven to
address the health inequities faced by rural and
regional communities and it is this force which
continues to fuel my passion for rural health.
Finally, I want to say a massive thank you and
congratulations to Ini and Anita, our lovely
Frontier! Publications Officers, and to Deepthi,
Kyra and Rashmi, our fantastic Frontier!
subcommittee, for all their efforts, passion and
creativity throughout the year. Your
contributions, from hours of brainstorming
themes, meetings, designing, editing and
reaching out to students and clinicians, have
brought this magazine to life in a mural of
reflections on rural practice to showcase both
the delights and - sometimes - difficulties
faced when studying and working rurally.
I hope this edition of ‘Frontier!’ is a gentle
reminder for you to slow down and take a
moment to reflect on your relationship with
medicine, and to consider all the possibilities
that rural health has to offer. Take a deep
breath and get ready for an exciting journey in
the upcoming pages!
Khue
Khue Le ,
2023
AMSA
Rural
Chair
F R O N T I E R ! | A M S A R U R A L H E A L T H | 6

AMSA/RANZCP Scholarship
Recipient - William Darmawan
Situated in the Riverina region south-west of Sydney,
Wagga Wagga is the largest inland town in New South Wales
and is home to the 325 bed Wagga Wagga Base Hospital. In
this reflective piece, medical student William Darmawan
shares some of the key takeaways from placement in
Wagga Wagga, reflecting on the strengths and challenges
faced in rural psychiatry.
My elective rural psychiatry rotation at
the mental health service of the
Wagga Wagga Base Hospital (WWBH)
affirmed my interest in pursuing rural
psychiatry. My experience working as a
Mental Health Nurse in Sydney and,
more recently, as a medical student in
Wagga Wagga, has highlighted the
challenges faced in providing mental
health services in rural areas.
The fly-in-fly-out model employed at
the mental health service in Wagga
Wagga has its benefits, but also its
challenges. This system was
implemented due to shortages of
psychiatrists and psychiatry registrars
in the area. From a medical student
perspective, it was encouraging to see
how the rural psychiatry workforce in
the area has improved since then.
More locally trained psychiatrists are
staying and working in the area, and
several current interns and residents
will join the training program next
year as psychiatry registrars. Utilising
the fly-in-fly-out model to bolster the
local psychiatry workforce ultimately
benefits rural patients, as they
increase access to specialist care and
provide better continuity of care.
I enjoyed the teaching, collegiality,
and support I received as a medical
student from the psychiatry team at
the WWBH. I had access to more oneon-one
teaching with psychiatry
registrars and consultants; as a result, I
was provided the opportunity to
receive meaningful mentorship, with
clinicians who attest to the unique
features of psychiatry.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 7

I enjoyed the collaboration process
within the multidisciplinary team to
address patients’ complex needs,
especially in rural areas, where they
have less access to services when
compared to their city counterparts.
My experiences working in rural
psychiatry also highlighted the
complexity of providing psychiatry
care to patients in rural areas. People
in rural areas generally experience
poorer health and welfare outcomes,
and they have unique risk factors for
mental illness. Reduced access to
health services, high-risk occupation
exposures like farming, access to
firearms, and greater travel distances
to tertiary centres present challenges.
This extra layer of complexity warrants
innovation in delivering psychiatric
care in rural areas. For example, the
use of telehealth psychiatry services in
providing emergency mental health
consultations, where it is otherwise
impossible to offer a face-to-face
service at one of thirty-two hospitals
servicing the Murrumbidgee Local
Health District, a vast geographical
catchment area.
My elective in rural psychiatry also
highlighted to me the wide range of
sub-specialties within psychiatry inself:
older person’s mental health, adult
psychiatry, drug and alcohol,
consultation-liaison, and private
practice in rural areas. There are also
plenty of opportunities for leadership
and advocacy in rural psychiatry.
These opportunities, combined with
the appeal of a rural lifestyle, are very
appealing to me as a medical student:
in essence, rural health offers excellent
work-life balance. At the same time, I
have found that psychiatry can be
especially rewarding due to the
altruistic nature of the profession.
Finally, I would like to thank AMSA
and the RANZCP for their bursary,
which allowed me to pursue and
affirm my passion for rural
psychiatry. I look forward to being a
part of the future rural psychiatry
workforce and will continue to
advocate for rural health.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 8

Madelyn Deigan
Flinders NT Medical
Program
I was lucky enough to complete a six
week rural psychiatry rotation in Alice
Springs, Northern Territory.
Throughout these six weeks, I not only
was fully immersed into the fascinating
world of psychiatry, but also privileged
to learn about the history and culture of
the region and the unique health care
challenges it continues to face.
It was my first time in Central Australia
and I was immediately drawn in by the
sense of community and how
welcoming everyone was.
I immediately
fell in love
with the
place and the
people.
Despite some negative attention in the
media, Alice Springs is an incredible
place, filled with rich history and culture
while surrounded by the most beautiful
landscape. I immediately fell in love
with the place and the people.
The psychiatry team itself was also
incredibly welcoming and offered a
very supportive environment, with a
large number of trainees and many
experienced clinicians.
The Central Australian Mental Health
Service covers an extremely vast area
including Alice Springs and the Barkly
region, plus many more remote
communities. This results in resources
often being stretched thin alongside
the logistical, cultural and social
challenges involved in patient care.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 9

Week 1 - Crisis Assessment Triage
Team (CATT) & Consultant Liaison (CL)
During my first week I spent time with
the registrar who was covering both CL
and CATT. This was a really great way to
gain insight into the kind of patients
seen by the service as a whole. I saw
patients in ED, on the wards, and in outpatient
appointments.
In a day, I would meet people postsuicide
attempts, people experiencing
situational crises, people with
diagnoses of BPD, schizophrenia,
depression, anxiety, psychosis,
substance abuse disorders, and more.
I learnt about the importance of
building appropriate therapeutic
relationships and having difficult
conversations between patients,
families, and other hospital staff. We
discussed countertransference, and
tuning into the emotions that you feel
when being in the room with particular
patients. It opened my eyes a lot to the
intricacies involved in assessing mental
state, particularly when complex
personalities play a role.
Weeks 2 & 3 - Child & Youth
I was initially apprehensive about doing
a Child & Youth term, as I am yet to
complete a paediatric placement, but it
ended up being the highlight of my
rotation.
Child & Youth psychiatry is so complex.
It involves working in a
multidisciplinary team, and working
with the children, their families, carers
and schools. I loved the emphasis on
non-pharmacological management
and ensuring problems are fully
explored through a variety of means,
including interviews, play, therapy,
teacher observations and more.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 1 0

Care of the child would be tailored to
their needs, and may involve care by a
psychiatrist, social worker, Aboriginal
Mental Health Worker, or a
combination of clinicians.
It was often heartbreaking hearing
about the trauma that so many kids
have experienced by a young age, and
which is often ongoing and
perpetuated by societal factors. We also
saw many kids with ADHD and Autism
Spectrum Disorder and it was
interesting to see just how diverse
presentations could be. Also discussed
were options about treatment and also
whether a diagnosis would be helpful
at all.
I was also lucky enough to travel to
Tennant Creek with the Consultant
Psychiatrist and Aboriginal Mental
Health Worker. Stepping onto the
RFDS flight, I knew I’d be in for an
adventure! Tennant Creek is a small
town 508km north of Alice Springs.
There is a small hospital there but
people have very little access to mental
health services, so the visiting
psychiatrist plays a crucial role. We saw
lots of kids experiencing behavioural
difficulties at home and school, often
with a range of complex mental health
needs and intergenerational trauma.
Stepping onto
the RFDS
flight, I knew
I’d be in for an
adventure!
We visited both the Primary and High
Schools, interviewing staff and families.
It was always like a puzzle, putting
pieces together to figure out the story
and how best to help the child and
those around them. It was challenging
at times, with long days, endless note
writings and what felt like the world’s
longest Mental State Examinations
(MSE), but it was so rewarding being
able to spend time with kids and help
them get the support they need.
Week 4 - Consultant Liaison (CL) &
Perinatal
Learning how trauma and other issues
throughout childhood shapes people,
and seeing the same problems
impacting adults, has given me a
greater understanding of how mental
health impacts people’s lives and
ongoing brain development.
We saw people with such a range of
issues. Some people were lonely, others
had given up on life. There were people
who were dealing with a range of
health conditions which contributed to
their mental health, including obesity,
physical injuries, pregnancy and more.
I also spent some time with the
perinatal health nurse who specialised
in narrative therapy. I loved this style of
therapy, as it empowers the patient
and helps them re-frame their mental
health to think about things they do
that benefit them in their lives. I also
got to attend a Families and Babies
group on emotional health, gaining
insight into new parenthood, seeing
new mums and dads coming together
to support each other.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 1 1

Week 5 – Community Mental Health
The Community Mental Health team
manages people on an outpatient
basis. On my first day we did a home
visit to a person with signs of recurrent
psychosis who self-recognised
symptoms and asked for help. It was
really reassuring seeing that they felt
safe to call the mental health team, and
that the team were able to provide
timely individualised care to his house
the same morning he called.
One particularly special thing about
rural areas is that you really get to know
people and become someone that the
community can trust. We also did a lot
of out-patient appointments, Clozapine
clinics, follow-up of people on
Community Mental Health Treatment
plans, and more.
In the out-patient setting, most people
are well enough to be happy to take
time to chat with a student, so I was
able to lead most of the reviews which
was incredible for improving my clinical
skills. In between patients, we
discussed formulation, mood disorders
and ADHD in adults, and reviewed
interesting cases together.
These
experiences
teach you more
than just
medicine - they
give you
perspective
into humanity
and the way the
mind works.
I saw psychotic depression with
extreme psychomotor retardation.
There was a man who had painted his
face white, others who seemed well
until sudden bursts of anger. I was also
able to sit in on several tribunals, which
were always engaging and made me
think a lot about the value of autonomy
and how challenging it is to balance
safety and freedom.
Week 6 – Mental Health Unit
My final week was in the Mental Health
Unit. It was a really beautiful unit and a
much more welcoming atmosphere
than previous mental health units that I
had seen. The 12 bed unit included a
high dependency unit, where there
were some extremely interesting
patients during my week there.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 1 2

My time in rural psychiatry was above
and beyond what I could have hoped
for. I had such a wide range of
experiences and felt encouraged and
supported as I built upon my
knowledge and skills.
During my time off placement, I
explored the beautiful surrounding
region. I went for runs along Larapinta
trail, visited beautiful rock holes, went
camping, and even visited Uluru-Kata
Tjuta National park. It was an absolute
life changing experience.
If you get the chance to experience
psychiatry in a rural setting; go for it!
It might just change your life.
M A D E L I N E W A S A R E C I P E N T O F T H E 2 0 2 2 A M S A X R A N Z C P
P S Y C H I A T R Y B U R S A R Y
Information and events for medical students and doctors interested in
psychiatry and mental health
Membership is free and forum members will receive a range of benefits including:
• invitations to educational events including lectures and workshops
• career guidance – seminars and advice from College Fellows on career paths in psychiatry
• invitations to participate in RANZCP awards, prizes and grants around promotion, research or advocacy in mental health
• select access to journal articles
• a monthly e-newsletter to keep up to date with RANZCP activities.
To join, visit: www.ranzcp.org/pif /psychiatryinterestforum

Collaborative
Reflections
.
A D V I C E F R O M Y O U R P E E R S !
TIPS FOR MAKING THE MOST OF
RURAL PLACEMENTS
“Go in with an open head and heart!”
- Crystelle Vanderplas
“Make sure to explore nearby areas
and make the most of being rural.
There are always activities to do like
wine tasting, festivals, markets and
more.” - Akshaya Thananjeyan
WHY DID YOU
CHOOSE TO ‘GO
RURAL’?
“I come from a
rural background
and despite moving
away for the
Melbourne metro
experience, smaller
communities
remain the places I
feel most at home.”
- Imogen Bowden
DESCRIBE YOUR RURAL PLACEMENT
IN 50 WORDS OR LESS
“The perfect setting of increased
clinical exposure paired with teaching
and learning supports”
- Imogen Bowden
F R O N T I E R ! | A M S A R U R A L H E A L T H | 1 4

Charlie Aitken is a Second Year
Medical Student at the Australian
National University, Canberra. Charlie
had the opportunity to travel to rural
clinical sites in Temora, Deniliquin
and Wagga Wagga in New South
Wales as part of the Rural Doctors’
Network “Go Rural” Trip, and shares
some of her reflections and advice in
the following interview!
Why did you choose to "go rural", and
what makes you want to stay?
Being rurally based (Armidale), but
having had the opportunity to live in
both overseas and Australian cities, I've
gained an appreciation of the difference
in health care accessibility in
metropolitan areas when compared to
rural areas.
'Going rural' was always the long term
goal for me as I really want to be a part
of helping to bridge this gap.
I've experienced the rural gap
firsthand as a patient or family
member so I really wanted to delve
into what it was like 'on the other side',
practising as a rural health
professional.
The immense support and
appreciation for rural medical
professionals - not just from the
community and patients, but also from
colleagues - is something that makes
me want to stay rural. Also, the rural
clinicians I met emphasised how I
would never have a boring day at work:
their cases are intellectually
stimulating and require them to
harness all the skills they’ve learned
over the years.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 1 5

What were the major differences you
noticed between rural and metro
placement?
A recurring theme was autonomy and
proaction. Rural practitioners seemed
to have a greater sense of initiative,
where if they see a problem, they go
out of their way to fix it. This was due to
the fact that they had space to do so,
and with many being sole practitioners
so having no alternative but to find a
solution.
For example, I met one rural GP who
started having parents presenting their
children for care following sexual
assault. With the closest clinic being
three hours away and staffed by an
unfamiliar health practitioner, this GP
worked towards getting a Masters in
Clinical Forensics so she could perform
the examinations herself.
Additionally, there was no Aboriginal
Medical Service in her locale so she was
able to establish one with the support
of her fellow rural healthcare
colleagues.
What are lessons that going rural has
taught you?
The sense of inclusivity and support
was absolutely palpable at my rural
health service. Despite their heavy
workload and great responsibility, all
the rural practitioners were genuinely
invested in the health and wellbeing of
their community and seemed to thrive
helping the community they cared
about with a variegated assortment of
presentations. I learnt that to provide
the best care means to show passion,
commitment and connection to the
community you're serving.
Visiting the Temora Hospital
and Imaging Facilities
F R O N T I E R ! | A M S A R U R A L H E A L T H | 1 6

What challenges have you faced
during your rural experience?
Grasping the fact that as a rural health
professional - due to lack of specialist
skills, understaffing, resource/facility
inaccessibility, or any other myriad
reasons - you may not always be able to
provide the level of care to your patients
as you might want to was a big
challenge for me.
That said, allied health professionals in
the area often had specialist skills, and
Rural Generalists complete advanced
training in at least one specialty area -
for example, anaesthetics or obstetrics
and gynaecology. Because of their
intensive training, they also act as the
local dermatologist, paediatrician, or
geriatrician.
They really have to be resourceful - a
‘jack of all trades' - due to the lack of
local specialists and tend to refer to
other practitioners less. This is quite
unique to rural healthcare.
What biases do you think people have
about working rurally? To what
extent are these true?
There’s a perception that working
rurally is very isolating and comes with
greater workload and responsibility.
From what I saw, working rurally is the
exact opposite of isolating: people are
much more involved in each other's
lives and genuinely care about one
another. Colleagues and community
members alike were so close with each
other and extremely supportive, not just
in an emotional way, but a practical way
too.
Working
rurally is the
exact opposite
of isolating: the
people here
genuinely care.
That said, the large workload and heavy
responsibility part is true. On average,
many of the GP’s seemed to work more
than their city counterparts, partly
because they were individuals who
relished the involved nature of their
work. It is also not uncommon to be
working as a solo practitioner.
Another bias people hold is that rural
health is ‘worse’ than metropolitan
health. Some areas of rural health do
seem to be comparatively ‘worse’ than
in metropolitan areas, notably due to
geographical inaccessibility of
healthcare services but also other equity
issues and socioeconomic determinants
specific to the regions.
Delayed presentations are very
common in rural areas. Patients know
how busy and understaffed rural
hospitals and medical facilities are and
don’t want to ‘waste their time’ with
their health complications, which they
often perceive to be smaller than they
are.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 1 7

You may just
prefer the rural
life, but how
will you know
unless you try?
Do you think everyone should "Go
rural" at some point in their life? Why
or why not?
I think everyone should ‘go rural’ at
some point in their life. It’s a new
experience to those who haven’t
encountered rural life and one that can
make you appreciate the accessibility
of healthcare in urban areas.
Completing placement, internship or
further training in a rural area would
enable you to get more hands-on
experience, and the staff actually value
your assistance. From a training
perspective, while you would learn a
broad range of skills, some specialist
training programs only exist in
metropolitan areas. However,
conversely, medical students and
junior staff may feel more like they are
literally or metaphorically standing in
the corner amidst the large and busy
teams.
I encourage you all not to discount
working out in rural areas, even if just
for a few years. The communities
desperately need more health support,
and are grateful for any help they
receive.
Share your best tip for making the
most of your rural placement!
Don't be afraid to ask as many
thoughtful and genuine questions
related to both rural practice and rural
lifestyle as you can think of!
Try and be as active a listener as you
can - health professionals in rural areas
have taken some amazing career paths
and have many stories to share, and
more importantly are so willing to share
them and their extensive skills.
How connected and close you become
to your community is a special aspect
of living in a rural area. You pick up
day-to-day habits that you could take
back to the city, especially being a
friendly and genuinely good person in
public because you tend to know
everyone.
Sunset in
Temora
F R O N T I E R ! | A M S A R U R A L H E A L T H | 1 8

BRIDGING THE
RURAL DIVIDE:
ENSURING
EQUITABLE
ACCESS TO
SEXUAL AND
REPRODUCTIVE
HEALTH IN POST-
COVID RURAL
AUSTRALIA
Lois Segun-Beloved is a third-year
medical student at Monash
University. She has a passion for
rural health, sexual and
reproductive health care and
intersectionality in medicine.
Having been involved in university
organisations and events around
gender equity and diversity, she is
excited and proud to be on of
AMSA’s Sexual and Reproductive
National Co-ordinators for 2023
F R O N T I E R ! | A M S A R U R A L H E A L T H | 1 9

As we emerge from the challenging
era of the COVID-19 pandemic, it is
crucial to address the lingering
disparities in accessing sexual and
reproductive health services, especially
in rural Australia.
The pandemic has exacerbated
existing barriers and created new
challenges for individuals seeking
comprehensive care. To build a
healthier and more equitable future,
we must prioritise bridging the gap in
accessing sexual and reproductive
health services in rural areas, ensuring
that all Australians can exercise their
reproductive health and well-being
rights.
The COVID-19 pandemic has further
highlighted the challenges faced by
rural Australia in terms of sexual and
reproductive health access. With
limited resources and healthcare
infrastructure, rural areas struggled to
maintain services during lockdowns
and faced reduced availability of
specialised healthcare professionals. In
addition, closing or limiting clinic
operations, disrupting supply chains
for contraceptives, and reducing
access to sexual and reproductive
health information further widened
the gap in rural communities.
Moreover, the pandemic resulted in
increased financial strain for many
individuals, making it difficult to afford
the cost of reproductive health
services. Job losses and economic
uncertainties have made it even more
challenging for rural Australians to
prioritise their sexual and reproductive
health needs.
As a result, we must recognise the
urgent need to address these issues
and ensure equitable access to sexual
and reproductive healthcare as we
move forward.
COMPREHENSIVE SOLUTIONS FOR
THE POST-COVID ERA
Strengthening Healthcare
Infrastructure:
Investing in developing and improving
healthcare infrastructure in rural areas
is crucial. This includes establishing
well-equipped clinics, reproductive
health centres, and telehealth facilities
to ensure individuals can access
services regardless of location.
Strengthening the capacity of
healthcare facilities and providing a
robust supply chain for contraceptives
and other reproductive health
products is essential.
We must
recognise the
urgent need to
ensure equitable
access to sexual
and reproductive
healthcare as we
move forward.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 2 0

Enhancing Telehealth Services:
The lessons learned from the COVID-19
pandemic have emphasised the
importance of telehealth. It allows
individuals to consult with healthcare
providers remotely, reducing the need
for long-distance travel and overcoming
geographical barriers. Telehealth can
also facilitate follow-up consultations,
provide counselling, and deliver
educational resources, empowering
individuals to take control of their
reproductive health.
Increasing Support for Healthcare
Professionals:
Encouraging healthcare professionals to
work in rural areas is crucial. Financial
incentives, scholarships, and
professional development opportunities
can attract and retain skilled healthcare
providers in rural communities.
Collaborations between urban and rural
healthcare facilities can also enable
sharing of expertise and resources,
ensuring comprehensive and highquality
sexual and reproductive
healthcare in rural Australia.
Promoting Comprehensive Sex
Education:
Comprehensive sex education
empowers individuals to make
informed decisions about their sexual
and reproductive health. It is essential to
prioritise comprehensive sex education
programs in rural schools, providing
accurate information about
contraception, STI prevention, consent,
and healthy relationships.
Equipping young individuals with
knowledge and skills will enable them
to protect their reproductive health and
make informed choices.
Community Engagement and
Awareness:
Building strong community
engagement and awareness is crucial
for addressing the stigma surrounding
sexual and reproductive health in rural
Australia. Collaborative efforts involving
healthcare providers, community
organisations, and local leaders can
facilitate outreach programs, public
campaigns, and support networks.
By fostering an
open dialogue
and promoting
inclusive
environments,
we can empower
individuals to
seek the care
they need.
By fostering an open dialogue and
promoting inclusive environments, we
can empower individuals to seek the
care they need and break down barriers
to access.
Let us seize this opportunity to build a
healthier and more inclusive future for
rural communities, where reproductive
health is not a privilege but a
fundamental right.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 2 1

Collaborative
Reflections
.
A D V I C E F R O M Y O U R P E E R S !
WHAT LESSONS HAS GOING RURAL HAS TAUGHT YOU?
“Whilst undertaking training on King Island, I learnt that the
role any individual plays within their community is amplified
with remoteness and closer social connectivity which makes.
Understanding place-based learning more proficiently
provided me with a new lens through which to view my own
learning journey
Also, I hold a deeper respect for the professional qualities of
confidentiality and trust required to care for other doctors,
nurses, or their family members..” - Crystelle Vanderplas
WHAT WERE THE
MAJOR
DIFFERENCES YOU
NOTICED BETWEEN
RURAL AND METRO
PLACEMENT?
“In rural hospitals, general medicine and
surgery are very prevalent. In metro
hospitals, there are so many more
speciality teams. I think learning in both
settings has its benefits.”
- Akshaya Thananjeyan
“It can be incredibly isolating and
made more difficult if your
personal support system is small
or far away.” - Imogen Bowden
ARE THERE
DOWNSIDES TO
COMPLETING
PLACEMENT IN A
RURAL LOCATION?
F R O N T I E R ! | A M S A R U R A L H E A L T H | 2 2

Within Roma, I shadowed the Mental
Health Team being a part of the E-Child
and Youth Mental Health Service, Adult
Mental Health Service (telehealth) as well
as face-to-face consultations with
mentally ill patients within the
Emergency Department and hospital
wards.
In the following bursary report,
AMSA/RANZCP Scholarship
Recipient Saleha Khan shares her
experiences being immersed in
the world of rural psychiatry
Whilst completing her final year in
medical school, Saleha Khan travelled
to the town of Roma, Central
Queensland, completing a seven week
placement in Rural Psychiatry. In this
article, she reflects on her experiences
exploring mental health. After she
graduates, she hopes to be an
advocate for mental health and all
aspects of rural health.
I was also able to travel to mobile remote
clinics in near-by towns, such as at
Wallumbilla Hospital, to deliver
psychological and medical aid to those
who were geographically disadvantaged
and had limited resources.
My aim was to develop mental health
literacy, suicide prevention strategies
and education on self-harm prevention.
These strategies address issues which
were most prevalent in these towns.
I undertook my elective placement in a
small rural town, Roma, Central
Queensland. This placement was from
the 8th of August to the 25th of
September for a duration of 7 weeks.
During this time, I was attached to Roma
Hospital for a community and hospitalbased
placement in rural healthcare with
a focus on psychiatry.
I chose rural psychiatry because I am
aware that there is an increasing
demand for medical professionals in
rural communities. I yearned to gain a
better understanding of and clinical
exposure to rural medicine and
experience what a career in this field
may look like.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 2 3

On further questioning, I screened for
other mental health disorders where
he was positive for auditory and visual
hallucinations. He explained how he
was told once by a GP to follow-up
with mental health services but due to
out-of-pocket costs and the stigma of
receiving mental health care in small
communities, he dismissed the
problem.
During Week 3, I had a four-day trip
with the Royal Flying Doctors Service to
travel to outreached towns such as
Longreach, Saint George, Chinchilla and
Charleville. Here, I witnessed a greater
prevalence of poorer health conditions,
higher rates of illicit drug and alcohol
usage as well as a lower socioeconomic
demographic of patients.
Many patients suffered from
schizophrenia, depression, bipolar
disorder or domestic abuse and had a
lack of access to specialist services.
In one such instance, I met a young
teenage boy within the Emergency
Department that came in following a
motor-vehicle accident.
Whilst taking the history of the
mechanism of injury, I glanced towards
his legs which I saw had self-harm scars
from razor blades across his thighs all
the way down to his ankles. He then
explained how this was a way of coping
with the domestic abuse at home.
In rural areas there is often
apprehension around seeking help
and a stigma that lingers with mental
illness. Additionally, 14% of the
country’s First Nations Peoples (3,654)
resided within this community and
hence this added the challenge of
delivering culturally safe care to
Aboriginal and Torres Strait Islander
People in the area.
In rural areas
there is often
apprehension
around seeking
help and a stigma
that lingers with
mental illness.
In Roma, doctors are challenged to
treat approximately 70-80 patients a
day. This leaves limited consultation
time and puts pressure on the quality
of the health care system. Without
access to tertiary hospitals, I wanted to
learn to provide safe healthcare by
navigating through potential barriers of
limited resources, stigma, and
discrimination.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 2 4

In my future
career, I wish to
advocate and
provide hope
for those
without
equitable access
to healthcare.
Accessibility of mental health care in
Roma continues to be an ongoing
concern. Poverty, reduced rates of
health insurance, long travel distances,
and a shortage of public transportation
create potential obstacles to accessing
mental health care.
The experiences within a rural based
hospital such as Roma Hospital allowed
for a deeper appreciation of psychiatry
as a specialty and the greater demand
for mental health services within these
regions.
Once I graduate, I want to utilise these
skills and learn to manage various
psychiatric presentations with limited
resources in rural communities of
Australia.
As I progress in my future career, I wish
to advocate and provide hope for those
without equitable access to healthcare
and gain a better understanding of the
issues they face. I hope to join
organisations where I can contribute to
governmental strategies in providing
patients with better quality of life and
reduced burden of disease and
participate in mental health promotion.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 2 5

Go further afield,
to get ahead in
yours
Apply now for a $1,500
FutureFocus grant to help fund
your elective.
BOQ Specialist is committed to supporting and
empowering the next generation of medical and dental
professionals, which is why we’re proud to be giving
10 students $1,500 each to put towards the costs of
their elective with the FutureFocus grant.
To apply, visit boqspecialist.com.au/futurefocus
and answer five simple questions.
BOQ Specialist. The bank for medical professionals
Visit boqspecialist.com.au/futurefocus or call us on 1300 160 160. BOQ Specialist – a division of Bank of Queensland Limited ABN 32 009 656 740 AFSL and Australian credit
licence no. 244616. Open to Australian residents, enrolled in 2023 in a medical or dental degree at a recognised Australian university. Eligible Entries can be made by completing
and submitting the application form at www.boqspecialist.com.au/futurefocus. The FutureFocus grants will be allocated to ten Successful Applicants in the sole discretion
of BOQ Specialist on the basis of the responses to the application questions. Applications open at 10:00am AEST on Saturday 1 July 2023 and must be received no later than
11:59pm AEST on Saturday 30 September 2023. Successful Applicants will be selected by the Judges by 17:00 AEST on Friday 20 October 2023 at BOQ Specialist, Level 22,
255 George Street, Sydney NSW 2000. Successful Applicants will be notified by telephone and email by Friday 27 October 2023. Full terms and conditions, eligibility criteria
and how to enter the FutureFocus grant are available at www.boqspecialist.com.au/futurefocus.

Originally working as a refugee
lawyer, Rebecca George is now a
second-year medical student at the
University of Wollongong. In this
article, she shares the journey that
inspired her to persue a career in
rural medicine
I'm hoping to one day pursue a career
as a Rural Generalist. Why? I’ve had a
number of experiences of rural life and
healthcare, having grown up as the
daughter of a rural GP. These
experiences, along with my own work
on a remote island as a lawyer, have
driven me to switch careers and work
towards greater access to healthcare
for rural and regional Australian
communities.
My mother became a rural GP later in
life, after she had practised as both a
teacher and a nurse. This change
coincided with late high school and
early adulthood for me, and I was lucky
enough to witness and hear about a lot
of her experiences - they were
fascinating.
She worked in several medium to small
rural communities, ending up as the
medical superintendent for a remote
border town. She was the sole doctor
for the hospital, medical practice, and
Aboriginal Medical Service in the
region. She treated everything from
ruptured AAAs to gored rodeo clowns,
all on her own with very few resources,
though a lot of initiative and passion.
She weathered mouse and locust
plagues, flooding, outbreaks of
pertussis and Q fever, and the
occasional town riot. She dealt with a
whole number of unsavoury characters
– often fleeing the law out in such a
remote community – but she also
made many beautiful friends who
loved the country and the town and
wanted to see their community thrive.
The stories she told me spoke of great
resilience and capability on her part,
and also the sense of community and
spirit of cooperation permeating these
remote towns.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 2 7

My own exposure to remote work and
healthcare primarily came during my
time working as the manager of the
legal team on Nauru. Nauru is one of
the smallest nation states in the world,
with very high rates of chronic disease
and illness. At the time, it boasted the
highest rate of type II diabetes
worldwide, and access to fresh food,
exercise opportunities and a healthy
lifestyle in general was limited.
The destruction of the island’s resources
from phosphate mining over the
decades had rendered the environment
inhospitable and unable to yield much
produce. Food and medical supplies
were either flown or shipped in, but it
was a common occurrence for these to
be delayed. Entrenched poverty, along
with high rates of alcohol and drug use,
meant that most Nauruans were
struggling to improve their health.
The only hospital on the island was
small, run down and lacking in the most
basic provisions. It was widely known
that anyone presenting to the hospital,
whether for a tooth abscess or a broken
femur, would be offered paracetamol
and not much else. There was a medical
centre available for staff working in the
detention system, but this was also
short-staffed, and most expats would fly
out for even the most minor medical
issues.
The situation for asylum seekers and
refugees housed against their will on
Nauru was a lot more dire. They were
often harassed, assaulted and
discriminated against. A lot of asylum
seekers had arrived by boat with preexisting
conditions arising from
inhumane treatment received in their
own countries, which were
compounded by injuries picked up
along the hazardous journey travelling
to Australia.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 2 8

On Nauru, years of neglect, abuse and
denial of even the most basic
healthcare provisions (sanitary pads
were often denied, medical
appointments refused by the
authorities and infections left to fester)
all culminated in a new host of medical
issues arising. Many ended up with
chronic kidney infections from the
harsh environment and lack of access
to primary care.
Psychological harm was experienced by
most individuals, and severe psychiatric
conditions developed in many over
time.
Inequality in
healthcare is a
major
predictor has
far-reaching
effects for an
individual and
community’s
success.
Doctors who visited the island tried to
do what they could, but medical
evacuation applications were routinely
blocked then, and there was only so
much paracetamol could cover.
My experience on Nauru taught me not
just the dire need remote communities
have for greater resources and
healthcare workers, but also the
difference a dedicated medical
professional can make when investing
the proper time in individualised
patient care.
As we are all taught, inequality in
healthcare is a major predictor of
negative outcomes in life and has farreaching,
knock-on effects for an
individual and community’s success.
But more than that, inequality in
healthcare is an injustice that we can
work towards erasing in Australia. Even
in a remote detention system like
Nauru, doctors who took the time to
properly invest in and advocate for their
patients provided some comfort for the
vulnerable individuals there.
Our own rural communities, and
particularly our Indigenous patients,
deserve the same investment, respect
and advocacy.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 2 9

Collaborative
Reflections
.
A D V I C E F R O M Y O U R P E E R S !
DO YOU THINK EVERYONE SHOULD "GO RURAL" AT
SOME POINT IN THEIR LIFE? WHY OR WHY NOT?
“Yes! It is really
important to
appreciate how
different healthcare is
in the rural setting.
Having a variety of
experiences in
different settings really
helps you understand a
patient's background
and can impact your
clinical practice.” -
Akshaya Thananjeyan
“I truly believe that going rural
is an invaluable experience.
Equally, I believe that all
students should experience a
metro placement. Both have
their challenges and strengths
that often complement each
other.” - Imogen Bowden
“Yes! Even doctors who want to
eventually work in a city should
because rural patients will get
referred to metro hospitals and it
is important to be sensitive to the
concerns relevant to these
patients.” - Anonymous
“A huge yes for all medical students!
Experiencing rural medicine encourages a lot of thinking
beyond the mostly black-and-white, siloed approach to
health regularly practised in more urban settings, with
seemingly unlimited resources. It is exciting, challenging, and
more than professionally rewarding.” - Crystelle Vanderplas
F R O N T I E R ! | A M S A R U R A L H E A L T H | 3 0

A Reflection of
Global Health in
Rural Australia
A B B E Y I S A A C
For my elective Global Health
Placement, I spent five weeks attached
to the Hunter New England
Multicultural Health Service (MHS),
mostly in Tamworth, but also with a
couple of days spent with the team in
Armidale. I’m not sure what exactly I
expected of the placement – I knew the
MHS worked in Refugee Health, liaised
with Healthcare Interpreters, and
supported the Health System to
provide the best care for Culturally and
Linguistically Diverse (CALD) patients –
but I didn’t have a very good idea of
what this would look like in practice.
Ultimately, I was surprised by the
tangibility of the work accomplished
and how direct a difference could be
made. I learned that the student prior
to myself had spent time auditing the
rates of interpreter use for consent in
the hospitals- and found the rate to be
around 50%.
I also witnessed in my initial weeks my
supervisor working hard to provide the
ED staff with a specific Computer on
Wheels (COW) for easily accessible
interpreter consultations. He also
facilitated staff education on how to
access the COW and the interpreter
booking service. It was easy to imagine
the kind of difference this could make
to CALD patients requiring an
interpreter presenting to a rural ED.
While I had encountered the need for
and use of interpreters in my GP
placement in Tamworth, there is a
much more prevalent CALD population
in Armidale, largely due to the
Australian Government’s resettling of
Ezidi Refugees in Armidale.
This stark data could then be fed back
to the hospital and not only used to
bolster efforts to improve, but alert
healthcare professionals that this was
actually an issue in the first place.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 3 1

From what I understand from
conversations with MHS staff, this
resettling was largely executed without
time or resources devoted to properly
establishing the services necessary to
support Ezidi families to the ideal
extent. That said, it's clear that very
passionate and committed healthcare
professionals have supported these
patients to the best of their ability,
regardless of regrettably being
somewhat under-resourced.
Through my visit to Armidale, I learned
that ‘Ezidi’ refers to a Ethnic and
Religious group who originally resided
predominantly in Northern Iraq, but
also parts of modern day Syria and
Turkey. Their main spoken language is
Kurdish/Kurmanji, and most of the
cultural and religious knowledge of
Ezidi people is passed on in the oral
tradition from generation to
generation, with very little knowledge
having been scribed. This makes
particularly devastating the continuing
persecution of the Ezidi people who, in
addition to losing family members and
loved ones, now also face the loss of
cultural, traditional and religious
knowledge and the subsequent
degradation of cultural identity. All this
loss must be extra keenly felt for those
who have been displaced from their
homes and community and left to
rebuild in new places with new culture
and language.
Though persecution of the Ezidi people
by various groups including Christians
and Muslims has occurred for hundreds
of years, the 2014 genocide carried out
by ISIS catalysed the mass Exodus of
Ezidi families from their land and into
refugee camps.
In this genocide, 2000 Ezidi men were
massacred and many more women
captured and sold into sexual slavery.
More than 50,000 Ezidi people fled into
the mountains where they faced
tremendous hardships.
An MHS nurse in Armidale told me of a
woman she had seen who was
pregnant when she was forced to flee,
gave birth in the mountains without
any medical care, and had to get back
up afterwards and keep trekking,
because any time spared to rest meant
possible capture or death.
Understandably, many Ezidi refugees
resettled in Armidale have significant
trauma associated with this horrific
event.
ED Data
In my work in the MHS in Tamworth, I
spent time examining data from the ED
for patients requiring an interpreter. I
looked at the rates of ‘Did Not Wait’
(DNW, referring to patients who left the
ED prior to being seen), examining the
monthly breakdown, relation of DNW
to language spoken, country of birth,
gender and age, the triage categories
of presentations requiring an
interpreter, primary diagnosis and the
rates of representation within 28 days.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 3 2

I found several striking results. The
yearly percentage of DNW
presentations for patients requiring an
interpreter was 13.8%, and I believe the
healthcare quality target is 4%. 13.8% is
roughly 1 in every 7 patients requiring
an interpreter presenting. Additionally,
after 30-39 year-olds, the two most
likely age groups to leave without being
seen (DNW) were 0-9 years-old and 70-
79 years-old – the oldest and youngest
age categories. This is concerning as the
eldest and youngest patients are often
the most vulnerable.
Also of concern was that 2 of the 70
DNW presentations requiring an
interpreter were triaged as Category 3,
indicating potential threat to life,
situational urgency or severe
discomfort/distress. Presentations in
this category are meant to be seen
within 30 minutes. More than half of
presentations requiring an interpreter
that DNW waited over two hours in the
ED.
Sadly, the prevalence of DNW was so
great that it was the most common
diagnostic category recorded for
patients requiring an interpreter.
Something else of note I found in the
data was that 131 of the 508
presentations requiring an interpreter
were representations within 28 days,
meaning over one quarter of
presentations requiring an interpreter
were representing within 28 days of
having previously presented.
Many of the parents of the families I
visited had come from large families in
Iraq – think 10 or more siblings – and
many of their family members had
been killed, captured or were missing.
Understandably this meant the adults
generally had some mental weight they
were carrying, also likely contributed to
by years spent living and working in
refugee camps which I’m sure could
not have been easy. Comparatively
however, their children seemed
surprisingly bright and carefree for all
the trauma they’d been exposed to,
which made me feel really hopeful for
these families.
There were however some barriers –
five experienced GPs had recently
retired or moved away from Armidale,
meaning that some 3000 people had
been left without a GP, with the
subsequent effect that the remaining
GPs were so swamped with new
patients that not one would take new
patients anymore. This is all too a
familiar story in rural towns.
Unfortunately this meant that newly
arrived refugees couldn’t be linked in
with such an essential service as a GP,
and I speculate that situations like this
could be contributing to the amount
and frequency of ED presentations, as
well as the rate of DNW presentations,
in rural towns.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 3 3

My favourite moment on the home
visits was when Gert, the nurse, needed
to talk to the Mother of the family alone
with the interpreter, so I took the
children into another room where the
Father joined us, and we took turns
playing a sort of bilingual Pictionary.
We’d draw something, like a flower, on
my phone and teach each other the
word for it in our languages, with me
saying the English word and the
children teaching me the Kurmanji.
Although I’m sure my pronunciation
was terrible, this was lots of fun and I’m
glad I could help Gert with the interview
this way and still build rapport even
without an interpreter.
The community spirit within the Ezidi
people I visited shone through – every
family offered us food and drink, and
made us comfortable in their home.
The last family I visited were in the
middle of having a lovely big lunch with
another family the nurse had seen the
prior week. The young woman we
visited who came over alone worried us
– we thought she might be extra
isolated living in a new place and
possibly ostracised from her
community too – but this turned out to
be needless, as she had been taken in
by her friend’s family and was living
happily with them. Seeing the families
smile together was a wonderful sight of
togetherness and hope.
I will always
advocate for
and facilitate
the use of
interpreters.
This placement has highlighted for me
the experience of culturally and
linguistically diverse patients in
Australia. I’ve gained insight into how
these patients interact with the health
system and vice versa and understood
measures that individuals can take to
improve health care delivery.
As a student and in my future career as
a doctor I will always advocate for and
facilitate the use of interpreters in
communication with patients who
require them, and I hope never to
underestimate the impact of putting in
a little effort to educate myself and
learn some of the culture or language
of a patient’s background. Particularly
in the home visits I attended this was
always a great way to build trust,
rapport and goodwill between the
patient(s) and healthcare professional.
It was also brought to my attention
during my placement time how underresearched
culturally and linguistically
diverse Australians are as a population
in healthcare. In my search of the
literature relating to culturally and
linguistically diverse patients and
women’s health, I found only 20 articles
globally relating to these topics in
general and noticed that as soon as I
searched for more specific women’s
health conditions with culturally and
linguistically diverse parameters, no
results came up. I’d like to continue
with the literature review to
understand the breadth of these gaps
in research. I’m extremely grateful for
the opportunities this placement has
given me, including the motivation to
try to and bridge those gaps existing
both in research and in direct clinical
practice in my future career.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 3 4

D R N I K I T H A K R A M A D H A R I
BEYOND RED
DIRT ROADS:
DISCOVERING
THE HIDDEN
GEMS OF
RURAL
HEALTHCARE
Dr Nikitha Kramadhari graduated
medical school from Western
Sydney University in 2020, and is
currently an SRMO on Pediatrics
Training Program at Westmead
Childrens. In this article, Dr
Nikitha shares her insights gained
as a rural medical student at
Bathurst Base Hospital, in which
she found a love and passion for
rural medicine, and plans to return
to a regional setting as a qualified
paediatrician!
F R O N T I E R ! | A M S A R U R A L H E A L T H | 3 5

Born and raised in Sydney, when I
thought about rural life the first thing
that came to mind was red dirt roads,
tumbleweed and kangaroos roaming
the town. There is plenty of all that but
in my experience, rural towns have all of
this and so much more!
As a medical student I was lucky
enough to have the opportunity to do a
year of study in Bathurst - a city in the
Central Tablelands of New South Wales.
Even before I went I was keen to go as
those that had gone in the years before
me had only positive things to say
about the experience, most of them
agreeing it had been the best year of
their degree. My experience certainly
lived up to this review!
It was a fantastic experience; the staff
there were lovely and organised
activities for us to make us feel
welcome. Given that none of us knew
anyone close by, everyone became
good friends and would congregate at
the one pub (that turned into a club)
not infrequently.
There were beautiful towns nearby, lots
of good places to eat and plenty of
experiences that we wouldn't have had
at metropolitan sites, like being able to
attend agricultural shows or help out at
the Bathurst 1000, a 1000km endurance
motorsport race run annually in
Bathurst.
Being in a
smaller hospital
meant you were
much less likely
to be lost in the
crowd.
This made for plenty of great learning
opportunities and a more fulfilling
clinical experience. We all liked it so
much that all 16 of us stayed on as part
of the first cohort of assistants in
medicine to help out during the COVID-
19 pandemic.
As a junior doctor, I chose to complete
my internship and residency in
Newcastle, during which I also
completed a rural term in Armidale, in
the Northern Tablelands.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 3 6

In the lead up, I found I was hearing a
lot about the difficulties that people
faced during their time in Armidale.
Hence, I was feeling apprehensive as I
made my 4 hour journey up from
Newcastle one dreary Saturday.
My time a rural junior doctor was
certainly eye opening. I experienced
first hand the difficulties of working in
an under-resourced rural hospital, with
less ready access to investigations and
specialty support.
However, this experience ultimately
gave me confidence in my skills and
taught me that there is always help to
be found in the form of experienced
nursing staff or seasoned consultants
who are just a 2 minute drive away.
Bathurst also
highlighted the
camaraderie
which comes with
working rurally -
everyone wanted
what was best for
the patients.
The patients’ experience through the
hospital was always the top priority,
resulting in patients who were
overwhelmingly grateful for healthcare
workers, going out of their way to show
appreciation for doctors who chose to
work in their town.
I have chosen to undertake specialty
training in Sydney, during which time I
will be rotated through metro and rural
sites.
Although I do not have a clearly
planned pathway ahead of me at this
stage, I hope to practise in rural or
regional areas in the future.
I definitely think that everyone should
experience working and living in a rural
area at some stage in their journey.
It may have its ups and downs, but
regardless of where you find yourself, I
can guarantee you will meet lovely
people and explore beautiful parts of
the Australian countryside.
Who knows - you might just fall in love
like I did!
F R O N T I E R ! | A M S A R U R A L H E A L T H | 3 7

Collaborative
Reflections
.
A D V I C E F R O M Y O U R P E E R S !
HOW HAS GOING RURAL IMPACTED YOUR MENTAL HEALTH AND WELL-BEING?
“Going rural was a really positive experience. The sense of
community was very strong, inside and outside of the
hospital. I got to explore places that I had never been to
before and go to events that I never would've known about if
I had not worked rurally.”
- Akshaya Thananjeyan
“Rural healthcare is definitely not worse
than metropolitan areas! Going rural
provides so many different opportunities:
from being part of a team, taking part in
the flying and retrieval services etc, and
allows you to specialise in different things.
I think rural healthcare is different to
metro healthcare but none is worse than
the other!” - Anonymous
DO YOU BELIEVE THE
STIGMA OF RURAL
HEALTHCARE BEING
“WORSE” THAN
METROPOLITAN AREAS IS
TRUE? WHY OR WHY NOT?
WHAT IS AN IMPORTANT WORD OF WISDOM YOU
LEARNED FROM A RURAL CLINICIAN?
“Rural health is about flexibility, being adaptable,
and most importantly, about the patient. Have the
courage to go rural!”
- Anonymous
F R O N T I E R ! | A M S A R U R A L H E A L T H | 3 8

My Journey in
Rural Australia
Dr Sugamya Mallawathantri
Dr Mallawathantri is a respiratory
physician who practices from the
Northern New South Wales regional
city of Tamworth. As well as being
known for its thriving country music
scene, the city of 65,000 also welcomes
over 1 million visitors each year.
In this article, Dr Mallawathantri shares
her inspirational journey from medical
student in Sri Lanka to the innovative
specialist respiratory physician who has
been fundamental in spearheading
pulmonary health initiatives in
Tamworth!
Hello there!
I am a Respiratory Physician who has
the privilege of working in Tamworth,
the ‘Country Music Capital of Australia’.
My subspeciality interest is pleural and
pulmonary interventions.
My story:
I come from a multicultural
background: my medical education
and Postgraduate Medical training in
General Medicine were completed in
Sri Lanka.
I then had the opportunity to complete
Postgraduate Training in Respiratory
and General Medicine in the United
Kingdom, during which time I was also
fortunate to work as a clinical Fellow in
the Pleural Disease Unit of St
Marguerite Hospital in Marseille,
France.
In my opinion, working as a specialist in
regional and rural Australian healthcare
settings is extremely rewarding. It gives
you opportunities to introduce new
skills to help geographically
disadvantaged patients.
The best example I can give here is that
prior to my arrival, suspected lung
cancer patients had to travel to John
Hunter Hospital to undergo
bronchoscopy or Endobronchial
Ultrasound Guided Transbronchial
Needle Aspiration [which is known as
EBUS]. I have started offering this
diagnostic procedure in Tamworth
which means that the rural patients
now don’t have to travel for 4-8 hours
to Newcastle, previously the closest
available location. This skill was highly
welcomed in the region when I applied
for the Respiratory Physician position.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 3 9

I have also introduced insertion of
indwelling pleural catheters to those
patients who have a malignant pleural
effusion with a trapped lung or have a
guarded prognosis, and soon I will be
introducing a medical thoracoscopy
service!
These patients were historically
transferred to a metropolitan hospital
where they had doctors with these
skills. Inpatient hospital transfers cost
approximately $3000 to $6000 per
patient. This is in addition to the cost of
the bed days stayed in each hospital.
Therefore, the introduction of this
service was cost-effective for the
hospital.
More importantly, patients get
treatment closer to home surrounded
by their loved ones - something which
cannot be measured in dollars and
cents.
When new skills are introduced within
regional hospitals, a magnetic pull is
created, drawing in trainees. This, in
turn, catalyzes the provision of higher
quality service delivery and contributes
to a surge in the number of doctors in
the region.
As the hospital gains recognition from
esteemed training authorities — for
instance, the Royal Australasian College
of Physicians — it strengthens the
hospital’s reputation and encourages a
surge in its appeal among trainees,
establishing a cycle of recognition that
becomes virtually inevitable.
Introducing new skills/services and
streamlining services in a regional/rural
health setting has multiple advantages
for the patients, health system and
training programmes.
Why Tamworth?
Tamworth Hospital has always
sustained an exceptional reputation in
maintaining collegiality amongst its
physician group. It has also earned its
praises for dedicated, high-quality
teaching for medical students and
Basic Physician Trainees.
We have a fully functioning
cardiac catheterisation
laboratory, permanent
pacemaker insertion service
and 6 operating theatres.
There is also a wellestablished
renal dialysis
unit and outreach service.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 4 0

I love living in Tamworth
because its local people
are the most friendly and
accommodating that you
will ever meet.
My driving time to the hospital is under
10 minutes which is a stress-free cruise.
I get to breathe fresh air and gaze at
the picturesque valley and majestic
mountains, all while sipping on a cup of
my favorite tea!
Living rurally also meant that I could
afford to buy a beautiful house with
plenty of space, and a garden that's just
the right size, with a pool. I would have
spent a lot more money to buy a house
like that in a metropolitan area.
Now, about the local scene – we're not
just about serene views and peaceful
drives. We kick off the year with a toetapping
bang thanks to the Country
Music Festival every January.
Weekends here mean strolling through
lively local markets, catching musicals
at our fabulous theater, exploring the
treasure trove of boutique shops, riding,
dancing and other activities.
And let's not forget about the
unbeatable Dr. O'Connor's weekly pub
night, lighting up Thursday with a
touch of camaraderie and good vibes.
It's the perfect gathering where our
staff members and medical students
come together to raise a glass, unwind,
and catch up.
If you’re looking
for a beautiful
place to call
home with a
perfect balance
of work and
lifestyle, you’ve
got to come to
Tamworth!
F R O N T I E R ! | A M S A R U R A L H E A L T H | 4 1

THE PANDEMIC
PRESIDENT
Written by: Andrew Cramb, James Cook University College of
Medicine and Dentistry
When the COVID-19 pandemic hit in
early 2020, the rural medical workforce
needed to rapidly respond and adapt.
Guiding efforts were seasoned Rural
Generalists like Dr Sarah Chalmers,
President of the Australian College of
Rural and Remote Medicine (ACRRM).
Serving from late 2020 until October last
year, Dr Chalmers ensured the rural
voice was heard in policy and strategic
discussions that guided Australia’s
health response to the pandemic.
Thank you for your time Dr Chalmers!
Firstly, how did the opportunity to
become ACRRM President come about?
Over the years, I’ve had some amazing
mentors through ACRRM, like A/Prof Ruth
Stewart, Professor Lucie Walters, and Dr
Maria Cowie. They’ve lived and breathed
rural generalism for decades and were
encouraging me to consider the role. It
wasn’t a particular ‘life goal’ for me, but it
has been an extraordinary experience and I
wouldn’t change a thing!
What was it like as president during
COVID-19 and how did ACRRM
respond to the pandemic?
There was certainly a lot of ‘rolling with the
punches’ to adapt our college and
registrars’ training during the pandemic.
A benefit of being rural is that we were
already well-experienced in delivering
exams for registrars remotely. The other
specialty colleges rely heavily on face-toface,
and we were the only college that
had an uninterrupted exam cycle, which is
something we are very proud of.
ACRRM had a big part to play in the
vaccine rollout, alongside the Rural
Doctors Association of Australia (RDAA).
Advocating for rural communities as part
of this process was a big part of the first
year of my presidency.
COVID-19 had been around for six or so
months when I came in, but it was still
quite an extraordinary time.
I've been referred to as the ‘pandemic
president’! It was back in the particularly
scary stages of the pandemic when we
didn't have a vaccination program,
Australia still had closed borders and there
wasn't very much domestic travel going
on.
Another significant COVID-related change
to navigate was the introduction of
Medicare rebates for telehealth
appointments. Rural and remote doctors
have been using telehealth for a long time,
so we did quite a bit around best practices
for ramping up the scale of telehealth and
we produced some great resources to
support practitioner education on
telehealth services.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 4 2

Outside of COVID-19, what else did
an ‘average’ day look like for you
during your time as ACRRM President?
The president's role is centred on
advocating for rural health and
participating in policy and strategic
discussions.
So, we were looking at some of the big
questions facing our profession:
I’m very thankful to be married to
somebody who is so supportive and to
my children who had to sacrifice a bit of
mum-time during my ACRRM
presidency!
How do we get more medical
students to consider rural
generalism?
How do we encourage better
teamwork between rural doctors
and other health practitioners?
How do we inform and direct
national policy?
There was a large body of work around
the 10-Year Primary Care reform
project, which has gone on to become
the Strengthening Medicare Task
Force.
It's so important
that rural voices
be represented in
these strategies.
It's so important that rural voices be
represented in these strategies and it
has been a huge honour to speak on
behalf of my colleagues at these
forums.
Beyond being president, my role as a
rural generalist didn’t stop, and neither
did my roles as a wife and a mum!
Whenever someone gets to do
something like this ACRRM
opportunity, there is always somebody
in the background keeping everything
ticking away at home.
You’re also keeping busy with your
work at JCU, what does that entail?
I work in the undergrad program as a
Coordinator for sixth-year students and
as a JCU GP training supervisor,
supporting GP registrar in the
workplace.
With my Advanced Specialised Training
in remote Aboriginal and Torres Strait
Islander health, I focus on talking to
students and registrars about the
practicalities, learnings, and
opportunities in this kind of medicine.
We’ve got some amazing students
coming through. Since I started work
on Palm Island, we have had two
incredible individuals on Palm Island
who took advantage of as many
opportunities as they could and really
flourished in a remote setting.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 4 3

The best thing is when I hear the health
staff and patients speak highly of them;
you can see they’ve become an
important part of the team. It's great to
be part of JCU’s program because it
resonates with the kind of career I've
had.
That might help more young doctors
consider making the move outside the
hospital system and experiencing the
joy of primary care in general practice,
particularly when it comes to rural and
remote areas.
I see it as an opportunity to contribute
to the future and be a role model for
students to show them where a career
in rural generalism can take you.
From your opinion, what’s a key
characteristic of a Rural Generalist?
One of the important traits rural
generalists need is clinical courage.
Rural Generalists are very adventurous
and adaptable people and given their
locations and limited access to
resources, they kind of need to be!
I think that when it comes to teaching
clinical reasoning at medical school, we
should be teaching students about
clinical courage; how to take
considered risks safely.
I think that when
it comes to
teaching clinical
reasoning at
medical school,
we should be
teaching
students about
clinical courage.
Now that your presidency term has
finished, what’s the next focus for you?
I’ve recently commenced a Medical
Superintendent and Senior Medical
Officer (SMO) role on Palm Island
(Bwgcolman), north of Townsville.
I was made aware of the significant
workforce shortage out there and it
lined up well with the end of my busy
president's schedule.
I am excited by the opportunity to
connect with the community of Palm
Island. For the last few years I have been
in fly-in-fly-out (FIFO) positions, which
has left me feeling ‘community-less’.
My previous experience of 15 years
working in remote areas in Arnhem
Land has been good training, but Palm
Island is a very different context and I
know I’ve got a lot to learn.
It’s a great privilege to be able to work
here; I’ve already learned a lot about
different ways of approaching health
from the people of Palm Island.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 4 4

You were at ACRRM’s RMA22
conference, the first in-person since
COVID-19. What were your key
takeaways from the three-day
conference?
I felt very uplifted by the whole
conference. The RMA Conference is a
wonderful celebration of all the positive
things rural doctors do for the health of
communities across Australia.
The inclusion of students and registrars
is something that doesn’t happen in
other specialties and it’s great to see in
the rural generalism tribe.
If I had to choose my favourite moment,
it would be the ACRRM Fellowship
Ceremony. It was by far the biggest
fellowship ceremony we've ever had,
and it was just an incredible experience.
There’s a lot of talk around our
workforce crisis and sometimes it can
feel a bit hopeless.
This ceremony was proof that there is a
younger generation of doctors who
understand the need for more general
practitioners in rural and remote
communities and are taking up the
challenge.
What would you say to medical students
and junior doctors to encourage them
towards rural generalism?
Rural generalism is an incredibly
satisfying job that can cover any of the
specialties they might be interested in.
You can start a day assessing a woman
in early labour and organise retrieval to
the nearest birthing centre, then spend
time with a palliative patient and their
family working through end-of-life care
choices. You can manage a few broken
limbs, counsel an anxious patient then
thrombolyse someone having a heart
attack in between.
Really, you deal with any clinical
situation that your patient presents you
with.
We’re seeing a lot of stories now where
GPs are not feeling very appreciated.
Rural communities are very good at
showing their doctors how much they
appreciate them!
You are part of a community, and you
can provide that next level of care
because you’re living there in the same
context as your patients.
Thank you so much for your insightful
responses, Dr Chalmers!
F R O N T I E R ! | A M S A R U R A L H E A L T H | 4 5

Collaborative
Reflections
.
A D V I C E F R O M Y O U R P E E R S !
WHAT MAKES YOU WANT TO
STAY RURAL?
“Working rurally is very rewarding as the
impact you have on a patient's life is often
very evident. Additionally, the sense of
community in the hospital environment is
great.” - Akshaya Thananjeyan
IF YOU ARE STILL A UNIVERSITY
STUDENT, WOULD YOU
CONSIDER DOING YOUR
INTERNSHIP OR FURTHER
TRAINING IN A RURAL AREA?
“Yes, I would consider going
rural because I want to
immerse myself in the
community and I'm
passionate about improving
health outcomes in rural
communities. I think rural
health will provide
challenging experiences but
that these will also be the
most fulfilling.” -
Anonymous
WHAT CAN THE NEXT
GENERATION OF HEALTH
PROFESSIONALS IMPROVE
TO ENHANCE THE QUALITY
OF RURAL HEALTH?
“Health professionals should
all be advocating for better
rural health outcomes and
working to improve equity.
Also, continually working
toward greater understanding
and knowledge of rural health
and the experiences of rural
patients.” - Anonymous
F R O N T I E R ! | A M S A R U R A L H E A L T H | 4 6

We are grateful to have been offered the perspective of an Enrolled Nurse of fifteen
years, who has mostly worked in rural and regional Victoria and is now training to
become a Registered Nurse. In this piece, the author shares nuances of rural health
that are often overlooked by those in cities, and advocates that rural placement
offers richly rewarding opportunities to challenge our preconceptions of living and
working rurally.
In the vast landscape of rural Australia lies a
relatively untapped wealth of experiences and
invaluable opportunities for health
professionals. While urban centres may offer the
allure of face-paced, high acuity work and
hyper-specialised services, the unique
challenges and rewards of rural healthcare
should not be overlooked.
For those fortunate
enough to embark on
their medical journey
in rural areas, the
breadth of experience
they encounter is
unparalleled.
Each day brings forth a plethora of patient
encounters that encompasses a wide spectrum
of medical, social and cultural needs. In one day
as a nurse in a regional clinic, you may find
yourself tending to infected wounds, supporting
someone experiencing financial abuse and
facilitating appropriate management for a
young person in a mental health crisis.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 4 7

In areas where specialist services are
fewer, simply helping patients to
navigate the health system can also be a
big part of the job. The nuances of rural
life certainly bring socio-cultural and
economic factors into play perhaps more
so than for our urban counterparts, and
the diversity of cases encountered in a
single day paints a vivid picture of the
multifaceted nature of rural healthcare.
Furthermore, as a student working in a
smaller rural team, you have the
opportunity to forge closer relationships
with not only your colleagues, but the
patients themselves, and the capacity to
be more hands on with their care than
you might in a bustling metropolitan
hospital.
Since the rise of COVID-19, we have been
learning in a hybrid world, and while
online learning undoubtedly has its
merits, any student who has had the
chance to immerse themselves in a rural
community can vouch for the
educational benefits. One of the most
important things we can learn, and
should continue to learn, is the provision
of culturally safe care.
Our regions are rich with the heritage of
First Nations people, who have
accumulated wisdom over their
thousands of years of stewardship of the
land.
Connecting with and
listening to the
Aboriginal and Torres
Strait Islander
communities in the
area you practise in can
offer invaluable
insights into family
health, gender-based
and age-aligned care
As rural health providers, it is our
responsibility to acknowledge how fear
of having traditional cultural practices
ignored can impact an Aboriginal or
Torres Strait Islander person’s access to
healthcare, and to work towards a
culturally safe way of practising
healthcare.
In addition to the educational
opportunities and gripping range of
presentations that rural study and work
provides, the lifestyle offered in rural
Australia is second to none.
The ability to so readily connect with
nature clearly differentiates rural life from
urban life. It is not difficult to imagine
that the sounds of native birds calling
one another as the sun elegantly rises
over the horizon might be more soothing
than the grating cacophony of traffic and
construction so often associated with the
city.
The serene respite of the rural Australian
environment can be more conducive to
reflection and mental well-being. Life in
general is calmer and less rushed, with
greater chance to achieve a healthy
work-life balance.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 4 8

Despite the undeniable advantages of
rural healthcare, many students are
swayed by what they perceive to be
more "glamorous" opportunities in
urban centres.
While it is true that exposure to
metropolitan medicine can glean a
more complete understanding of
Australia’s healthcare system as a
whole, according to the Australian
Bureau of Statistics (2018), around 30%
of our population resides outside of
major cities.
It is imperative to cater to the needs of
our rural and regional communities,
addressing issues such as healthcare
avoidance, distrust, and hesitancy
which are prevalent in rural areas.
Education on telehealth and fostering
connections between generalist
doctors in the regions and specialised
professionals can bridge the gap and
provide the necessary support to rural
patients and their families.
From the outset, we
need to be promoting
the merits of rural
healthcare work: it
is crucial that all
medical courses
incorporate rural
health components
into their
curriculum.
Of course, working rurally does come
with its challenges. It can be more
difficult to access educational
opportunities and services such as
childcare, which of course make it
possible for healthcare professionals
with children to work in the first
place.
In the workplace, you may find
certain attitudes more prevalent than
in more liberal city suburbs -
healthcare avoidance and distrust,
reluctance to discuss potentially
embarrassing topics such as sexual
health, and traditional views on
gender roles are some examples.
With rurality comes different
industries and increasing vulnerability
to the havoc that nature can wreak.
Those working in the regions should
pay specific attention to the
intricacies of farmer health, and
natural disaster management.
Patients’ situations can be more
complex, involving factors such as
informal caring, domestic violence
and poor access to transport,
complicated by systemic issues which
slow their access to care.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 4 9

In addition, personal experiences have
revealed a relative disregard for the
value of a Master’s degree or other
higher education, especially in the field
of nursing. Higher qualification may
not be valued as greatly as a longer
period of service for example.
Despite this, Nurse Practitioners are
increasingly being utilised to address
the shortage of General Practitioners in
rural Australia. Given that GPs
unfortunately often spend limited time
in rural or remote areas before moving
on or reducing their hours, alternative
solutions such as Virtual Emergency
Departments (VVED), Doctor-On-Call
services and greater reliance on Nurse
Practitioners have become
commonplace.
Additionally, programs like the
Paediatric Infant Perinatal Emergency
Retrieval (PIPER) play a crucial role in
ensuring timely and specialised care
for paediatric emergencies in rural and
remote areas.
These programs, along with initiatives
like the Australian Rural Virtual Medical
Education (ARV), provide invaluable
assistance and support to healthcare
professionals working in rural and
remote areas where staff is limited.
These are all issues we need to
overcome in order to provide the care
that the people of our regions deserve.
By embracing
technology, rural
areas have better
access to healthcare
specialists,
including allied
health practitioners,
psychologists and
social workers.
As COVID-19 has proven, technology
can also increase the availability of
education. Furthermore, advocacy
efforts and strengthening of primary
health networks can help address the
gaps in essential services in rural areas,
such as mother-baby units, detox
facilities, and mental health services.
F R O N T I E R ! | A M S A R U R A L H E A L T H | 5 0

A S S T U D E N T S , W E H A V E T H E
P O W E R T O S H A P E T H E F U T U R E
O F H E A L T H C A R E .
B Y E M B R A C I N G T H E R I C H
T A P E S T R Y O F R U R A L
H E A L T H C A R E E X P E R I E N C E S , W E
C A N B R O A D E N O U R
P E R S P E C T I V E S , F O S T E R
C U L T U R A L S E N S I T I V I T Y , A N D
A C T I V E L Y C O N T R I B U T E T O
C L O S I N G T H E U R B A N - R U R A L
D I V I D E I N H E A L T H C A R E .
L E T U S N O T C O N F I N E
O U R S E L V E S T O T H E C I T Y -
C E N T R I C M I N D S E T B U T R A T H E R
S T R I V E F O R A H E A L T H C A R E
S Y S T E M T H A T E M B R A C E S T H E
N E E D S O F A L L , R E G A R D L E S S O F
G E O G R A P H I C A L B O U N D A R I E S .
T H E J O U R N E Y M A Y B E
C H A L L E N G I N G , B U T T H E
R E W A R D S A R E I M M E A S U R A B L E .
F R O N T I E R ! | A M S A R U R A L H E A L T H | 5 1

A M S A R U R A L H E A L T H
FR NTIER
THANK YOU FOR READING!
UNTIL NEXT TIME