Working rural and remote: rewards and challenges: meeting the health needs of remote and rural communities can be a challenging task. Under harsh conditions many nurses and midwives are working in innovative ways to ensure remote and rural Australians have access to the quality health care they require.

• Jurisdiction: Australia
• Author: Anderson, Kathryn
• Date: 01 February 2012

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Cattle station health care

Registered nurses Adrienne and Nia Evans spend their days visiting cattle stations in the Northern Territory providing health care to workers and their families.

During the dry season the married couple, visit 36 stations including ranger stations and outstations. Based in Katherine the nurses travel up to nine hours a day to set up their clinics Adrienne says. "lt usually takes six or seven weeks to get around to them all once and then we do it again."

The nurses usually arrive at the cattle stations in the afternoon and set up to provide anything from primary health care to attending to a variety of injury presentations. "We really are 'generalist specialist'; we never know what we are going to get confronted with," says Adrienne.

The nurses conduct adult health checks such as blood pressure and heart rates, cholesterol levels and Pap smears. "We also provide sexual health checks, support people if they want to stop smoking or if they want to reduce their drinking," Adrienne says.

Additionally, Adrienne and Nia spend much of their time providing emotional support. Both previous dairy farmers, from Tasmania and New Zealand, the couple are well qualified to be empathetic to the emotional needs of the cattle workers and their families. Adrienne says they feel a commonality with the station people. "Obviously the farming practices are very different, but animal health is the same and we have a basic understanding of the financial difficulties and the stress that comes with the job. When the Live cattle trade affected them all, we had a bit more of an understanding than possibly someone in the city would have."

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Adrienne believes the primary care they provide is paramount to chronic disease management in these communities. "We can help provide a better quality of life for these people. Last year we were really excited because we saw a lot less sexually transmitted diseases than what there has been in the past, so hopefully some of those safe sex practices [messages] are getting out there."

The couple work for Katherine West Health Board Aboriginal Corporation, funded by NT Health. Adrienne says their organisation was originally run by NT Health until the local Aboriginal people asked the government if they could manage their own health care. "The government agreed so we are now run by a board of management that is all Indigenous people from our area."

After seeing Aboriginal people having their health needs met, Adrienne says the 'white fellas' on the cattle stations wanted better health care too. "So that's where our job was put into play--by providing health care to the station people."

Helping older Indigenous Australians stay at home

Enrolled nurse Shane Smith is case manager for older Indigenous Australians. He is employed by Transitional Aged Care Services in the Shoalhaven region situated 200kms south of Sydney. As part of a team of nurses and allied health care workers, Shane works to keep Indigenous Australians in their own homes through holistic restorative therapy. "Since the program started 12 months ago we have managed to keep all 10 of our clients in their own homes," he says. "It's important to keep older Aboriginals at home within their community. Most of the Aboriginal elders are wary of institutions and they want to stay within their Aboriginal communities."

Being indigenous, Shane liaises with the team on cultural issues. He is trusted by Indigenous communities which helps the team provide the care that is required. "It really helps being known to the community and the elders; that trust is already there."

Shane also educates Aboriginal people about the health services available to them. "It's about getting local Aboriginal people to trust in the hospital system. Sometimes this is...