Section 2: Adapting to your new town and your position within it
Moving to a new town during placement provides a great opportunity to integrate within that community and take on a new role. Health professionals in rural areas must learn how to juggle living in close proximity to their patients; there is an art to being able to maintain patient confidentiality when you’re also playing sport with them and seeing them in the supermarket!
All communities have their own culture and subcultures. As with any cultural learning experience, unwitting errors or embarrassments may be part of your process of adaptation. In adjusting, remember flexibility, sensitivity, respect for difference, a non-judgemental approach and optimism are key factors for developing positive relationships.
Keep in mind you are a new cultural element too, and your new community will want to know about you and adapt to you. People have different ways of getting to know each other, so be prepared for direct and indirect questions and be open to opportunities to meet new people.
However, taking care of yourself should always take precedence. You don’t have to befriend everyone or tell strangers your life story. You should not have to pretend or act differently in this new community. Be yourself, take care of yourself, and do your best in your role as a health professional by putting yourself first. Surround yourself with a good support network prior to moving to placement, and don’t forget that they exist. You are not alone, and your new community may present an opportunity to meet new friends and contacts.
The experiences you will have while on placement in a rural community can be very different to a metro placement. Some people assume that because they are going to a small community there won’t be much to do on placement and that it will disadvantage them when looking at training pathways down the track. However, rural placements provide a great array of health concerns and tend to be more hands on than city-based placements. Australia’s rural and remote communities often struggle to fill healthcare positions, so your help is greatly appreciated. Rural health professionals must have a wider scope of practice than their city counter parts, which means that you will see and be involved in managing a much greater variety of diseases. For more info see the NRHSN’s Rural Placement Guide.
You may get to know many patients socially, which may make some community members reluctant to access health services. People may also be unwilling to acknowledge a problem for fear other community members will find out. Patients may have to travel long distances to see a health professional or may wish to travel to another area to avoid seeing someone they know in their own community.
It is imperative community members can trust their personal information is never shared with anyone. Socialising purely as a friend with community members, who may also be your patient, may feel awkward at first but soon you will settle into your dual roles within the community. If you feel unsure about how to act, seek out an experienced health professional in the community who can give you some advice. When in small communities it may be useful to discuss this with the patients you see and ask how they would like you to act when they see you in the community setting, that way you will both be on the same page.
General health in regional and remote areas
Research by the Australian Institute of Health and Welfare (AIHW) demonstrates that health levels for people living in regional and remote areas are often lower than those of people in metropolitan areas.
Poorer health is multifactorial and may be reflective of socioeconomic disadvantage, distance from health care services, lower educational levels and increased occupational risks. However, AIHW research also found that in regional and remote communities there were higher rates of social cohesion, and people were more likely to participate in volunteer work and feel safe in their community.
Anxiety or depression in regional and remote areas
Mental health disorders are a large contributor to the total burden of disease and injury in Australia. It is important to be aware of this when on your placement and to be very clear about local services, policies and strategies.
Results of research from the AIHW show non-Indigenous males, Indigenous females and Indigenous males living in regional and remote areas are more likely to experience depression than those living in major cities. Anxiety is also a major contributor to ill-health for all Australians.
Rates of suicide are higher among rural men (both Indigenous and non-Indigenous). Despite increased social cohesion rural individuals are more isolated from friends and family. Farmers, the homeless, and the elderly can be vulnerable within these communities.
For Indigenous communities, social and emotional wellbeing is a holistic concept encompassing health and mental wellbeing but acknowledges the significance of connection to culture, family, community and land. There are also significant differences in mental health knowledge between Indigenous communities. This is reflective of the very different histories, cultures and individualism of each group. While some communities consider mental health a facet of holistic care, others consider mental health a reflection of personality. This is an important consideration in approaching the topic with Indigenous individuals as their perception of mental health will greatly affect their own lifestyle and treatment.
The AIHW have some great strategies and suggestions on how to support Indigenous people with their mental health.
Some universities and workplaces provide opportunities for cultural awareness training, so ask if this is available. Your best contacts for information and advice are the Aboriginal and Torres Strait Islander Health Workers in the community of your placement.
Further mental health strategies for Indigenous people can be found at the Menzies School of Health Research.
A person who has experienced physical, emotional and/or mental abuse is likely to be very distressed and this may put significant stress on you. The information below should not take the place of the local protocols of the health service of your placement, rather it is meant to be a starting point to consider issues that may arise.
If a person discloses an abusive experience, you should explain to the person that you need to advise your supervisor and that the issue will be treated in strict confidence. Your supervisor has the advanced skills and professional contacts necessary to deal with these situations. Under national guidelines some situations need to be reported (mandatory reporting) and your supervisor will manage this.
It is important to involve your supervisor as soon as possible, but if you’re in a situation where you are the only person available, do not ask leading questions, but let the person you are consulting with tell the story in their own words as this can influence further investigation.
Document the conversation in the notes using an ‘I said’, ‘He/she said’ format, if possible, trying to use their exact words. This should be countersigned by your supervisor. Make sure to have a chat to your supervisor before you start your placement and ask them direct questions about what to do if cases are presented to you regarding issues such as underage sexual abuse, physical or mental abuse.
Make sure that you debrief with skilled people and use the support services that are listed in this guide. They are there to help you. Your supervisor and university should also provide strong support for you.
Stigma of mental health
Mental illness, including depression and anxiety, still attracts a lot of stigma across Australia. Stigma and shame can influence how people raise their mental health concerns and it may take several consults to get to the heart of the problem. Cultural beliefs may mean emotions are expressed differently from the ways you would recognise.
Some minority groups are at a greater risk of mental health problems. AT particular risk are migrants, LGBTQI+ individuals, small ethnic groups, the disabled and the elderly. Regional and remote areas often provide less support for minority groups and their identification may not be normalised within the community. One of the best ways to help is to equip yourself with resources to share with these individuals. For example, knowing what community events are on and how elderly people may access them can them help reintegrate within their community. LGBTQI+ individuals might feel more comfortable disclosing their problems if they see an acknowledgement of LGBTQI+ support at the practice (for example, a discrete poster, or by you yourself within the clinic). You can also provide support by being knowledgeable of specific counselling services available to them, some of which are listed for both yourself and patients below (see Section 8).