00:09:16 Redouane Hadjij: good morning dr hadjij redouane from algeria
00:11:29 Bruce Chater: Welcome Redouane – It is pleasure to have you join us
00:12:18 Redouane Hadjij: it is pleasure for me too
00:12:33 Zakiur Rahman: Good evening from Bangladesh 🇧🇩
00:13:27 Anthony Cordero-Philippines: Good day everyone!
00:33:19 Bruce Chater: add any questions as they come to you:-)
00:35:41 declanfox: This gives the lie to health service managers and politicians who close smaller units and centralise and “rationalise” using the argument that low volumes are unsafe–we even had this in N. Ireland with the Omagh obs unit having two full-time OBGYNs and three residents being closed in the name of “safety.”
00:37:53 James Rourke: such bad decisions as high outflow communities have higher maternal and newborn morbidity and mortality!
00:42:01 Jerry Cowley: The older dctors here in reland were required tohave anaesthetic and obstetric skills like the woden stool but not anymore so deskilled in this regard.
00:43:04 Bruce Chater: Maybe Limerick University can bring it back!
00:43:07 Jerry Cowley: Ireland is only 32,000 square miles siso nothing like Canada or Astralia
00:43:45 declanfox: And we could talk all day about how that gradual deskilling happened. My older colleagues here in rural N Ireland in the 1990s talked about simply getting worn out doing community obstetrics.
00:44:34 Jon Dowell: My grandmother was a rural GP in rural Lancaster
00:44:43 Bruce Chater: yes – needs to be sustainable for practitioners too !
00:44:46 Redouane Hadjij: I think that rural family medicine is on the move, how to link this development with training to be more efficient? how attracted the attention of those in charge of the universities of this development ?
00:45:15 James Rourke: different places need made to measure bespoke solutions that take into account geography and demography realititeis
00:45:34 Jerry Cowley: Its so much safer now here in ireland in other less developed countries i’m sure its the essential lifeline to have those skills
00:46:22 declanfox: The sustainable aspect–I remember Gavin Young, a family doc in Cumbria, England who did community obstetrics, talking about how to ensure the doctor survived. I think that has to be one of foundations of extended services, whether OBS or surgery or ED
00:47:32 James Rourke: the quadruple aim is the triple aim plus sustainable supported health work force
00:48:27 Jerry Cowley: In Ireland we have highest Cvid rate now1
00:48:50 declanfox: The new medical school here in N. Ireland hopes to open this year and set up a rural/remote stream with longitudinal clerkships.
00:48:53 Jon Dowell: Oops, hit return early. she attended 1400 home deliveries, I can only imagine! it seems to me that some metric of accessibility is needed, rather than population density, town size etc. Ideally including retrieval team access in bad conditions to consider risk. Those working in the most challenging sites being trained, supported, funded in the light of this overall context.
00:48:54 Billy O Connell: Excellent,…every medical student should see this presentation
00:50:05 Nataša Mrduljaš Đujić: Is it possible to send us all this presentation? Thank You very much. Nataša
00:50:13 Ewen McPhee: Thank you Jim
00:50:20 Elizabeth Nwasor: thanks for the presentation
00:50:31 Redouane Hadjij: bravo
00:50:41 Randy Longenecker: What scope of practice is required to call someone a generalist?
00:52:13 declanfox: I think there is the central core of skills with each doctor having some additional “specialist” skills. Central core includes pre-hospital emergency care, office medicine, peds, mental health, retrieval skills……
00:52:23 Jerry Cowley: Fantastic presentation Jim – a licky population tohave your imput.
00:52:35 Jerry Cowley: Thats lucky
00:54:39 Pratima Durga: Thank you for the presentation 🙂
00:57:15 Randy Longenecker: How do we “show that it can be done?” We have an evidence base in literature, but urban specialists still can’t believe it.
00:58:32 Randy Longenecker: Buildings, teams, and training infrastructure
00:58:40 declanfox: Randy, some of it is down to urban specialists and managers stuck in their own belief systems and perhaps the only way through that is just keep pushing and insisting that THEY produce the evidence to support their decisions.
00:58:50 Bruce Chater: show successful communities to other communities and let the talk to the politicians about why can have one!
00:59:35 declanfox: We did that in rural PEI, Canada and it took a long time–worked eventually but I can understand people simply giving up.
00:59:44 Randy Longenecker: I agree – bright spots!
01:06:48 John Wynn-Jones: Hi Bruce We are seeing an interesting phenomenon in UK. There are many hospital specialists who have been so traumatised by the horrors on managingCovid and want a rich change in their lives and move to rural areas, where they can get a sense of community. Perhaps a valuable future asset
01:07:34 declanfox: Now that is interesting John–indeed one to watch
01:13:36 Bruce Chater: We have EM doctors with similar aspiratiosn – we offer through ACRRM to retrain them – the do need that
01:13:45 James Rourke: to get action from government, it helps to focus on the patient (voters) need to access care. As part of that establish equity targets for the public to demand and then help advise re rural-focussed programs to improve equity and measure progress as driver
01:15:25 Ewen McPhee: Virtual care caries great promise, as long as community and clinical teams in the remote locations are literate and adaptive.
01:15:55 declanfox: Jim I think rural folks have been getting the hind teat for so long that they almost expect not to be heard–again a slow process needed–repeatedly insisting on the evidence behind funding decisions
01:16:20 James Rourke: agree!
01:16:38 Randy Longenecker: It takes a “special” person on both ends of the tele-connection – a rural generalist and an urban specialist.
01:16:42 Ewen McPhee: First Nations people can drive these changes to support such things as birthing on country, access to critical care, establishing a unified clinical record.
01:17:07 Bruce Chater: yes need NEW MODEL of FM
01:17:30 declanfox: and good, robust, easy-to-use EMRs are crucial
01:17:45 Ewen McPhee: There is, in my opinion, a pervasive dumbing down of the Family Doctor, to the point that Rural Generalist medicine is seen as a threat.
01:18:30 Ewen McPhee: This creates real challenges for Fundholders and for Early Career Clincians
01:18:35 Bruce Chater: The students must be trained in rural
01:18:39 declanfox: as in, rural generalism is viewed as way too difficult and dangerous?
01:18:46 Ewen McPhee: Yes
01:18:48 Bruce Chater: builds the academics like Jim
01:20:03 Ewen McPhee: I would love to better understand how I could build a focus on supported rural family doctors to do research.
01:20:16 declanfox: Remember Julian Tudor-Hart’s research in Wales? When he talked about his daily work to the RCGP academics in London, they could not conceive of his type of practice. Things have moved on since that but there is still an awful bias against rural
01:20:21 Elizabeth Nwasor: I’m Professor Elizabeth Ogboli Nwasor from Nigeria.
I am happy to be here
01:21:05 John Wynn-Jones: Can we say something about compulsory rural service and the damage that this can do
01:23:44 John Wynn-Jones: I remember meeting a young doctor from Columbia who went to rural practice immediately after qualification. He had an awful obstetric experience with no support which scared him for life and would never again work in rural practice
01:23:49 James Rourke: good point, Anthony, underlines the importance of GPs working with the decision-makers to make change
01:25:07 James Rourke: different settings need different roles for rural GPs
01:32:18 Roger Strasser: Jim… Thank you for your excellent, comprehensive presentation that triggered such a rich, wide-ranging discussion… Roger.
01:32:55 John Wynn-Jones: Excellent Jim Thank you. Love to Leslie
01:33:06 Redouane Hadjij: thank you jerry
01:33:27 declanfox: Excellent presentation Jim and I learned some new things today.
01:35:52 Redouane Hadjij: it is my first time here i am very happy , i learned thank you all Merci.
01:36:23 Bruce Chater: Quote of the night – If you can’t see it you can’t be it RS
01:37:13 Randy Longenecker: Well said!
01:41:08 Lizzy Igbine: The major medical situations innour Country stems from Mslnuttiyio.
01:41:20 Jerry Cowley: working with the academic Irish cllege of Gps as a rualdoctors group with the suport of universities is key I think for the future
01:41:56 Redouane Hadjij: yes good point
01:41:59 declanfox: I agree Jerry–we need the academic input
01:42:40 Lizzy Igbine: Malnutrition issues are lare rampant in our Rural communities. from Lizzy Igbine
01:44:04 Redouane Hadjij: can commission wonca rural be a world academic ?
01:44:06 declanfox: Lizzy, the rural doctor may be the only person in that community with any hope of influencing managers and politicians and even then, a very difficult job
01:45:27 Bruce Chater: other quote of the night Redounae – we need a new family medicine model tat address communities needs in rural
01:46:12 declanfox: Inevitably, we move into politics…
01:46:23 Jerry Cowley: Limerick Ireland from 17 -20 june either virtually or in person theres aone hundred thousand welcomes to ruralwonca – loking forward to continuing the wonderful and relevant cnversation. great presentationand chat today – we can all doit together Inspiring presentation jim roger bruce reduaine declan lizzy elizabeth john anthony- ewen thank you all for excellent comment
01:46:37 Bruce Chater: Redouane – goofd point also that need curriculum internationally
01:47:17 Rick Botelho: Ask Big Hairy Audacious Questions about why equity and sustainability matters. Rural Wonca is leading the way. https://www.linkedin.com/pulse/bhaq-2021-ask-big-hairy-audacious-questions-rick-botelho/
01:48:31 declanfox: Thanks Rick
01:49:32 James Rourke: Thx everyone! keep pushing for rural health!
01:50:35 John Wynn-Jones: Thanks Bruce for your wonderful leadership
01:51:14 declanfox: Thanks to all for a great meeting and looking forward to the remaining sessions.
01:51:52 Zakiur Rahman: Thanks all