Aug 20

Aug 20 My Rural Diary About Benalla's Health, Victoria.

June 2019 - July 2019

I wanted to visit a small rural town that was outside of Queensland so I could see what Australia had to offer. I ended up in a small quaint city called Benalla in Victoria. Overall, I really enjoyed Benalla and decided to look up at its health and see how a rural town was doing compared to a major city.

Benalla Rural, Andreas Astier. — So what is the community like?

Here is a description of Benalla when I visited for a month.

Benalla is a small quaint city located on the Broken River and is the home place of the Taungurong people with the local Aboriginal tribal group called the Bhrenawlla. It was first discovered by European settlers Hamilton Hume and William Hovell. Around Benalla is Benalla surrounds and its main economy is agricultural support, manufacturing and tourism and is noticeably a retirement city with a high ageing population. Situated 200 km North-East of Melbourne,170 km East of Bendigo, 47 km South-West of Wangaratta and 675 km South West of Sydney, Benalla is thus classified on the MMM (2015) as a 4 and the ASGS RA (2016) as a 2. Hence, Benalla city is an Inner Regional Category.

The total population of Benalla is 13 975 with a population of Aboriginal and Torres Strait Islander of 224 (representing 1.6%). There are 49.1% males and 50.9% females, and the median age is 48.8 years compared to Victoria and Australia 37 & 38 years respectively. 5.3% of people are unemployed, however, this number dropped slightly as there were constructions near the hospital. 58.4% in Benalla are in the working-age population (aged 15 - 64 years). The children aged 0 to 14 years make up 16% of the population and the people aged over 65 years and over makes up 25.4% of the population (which is huge!) and hence the percentage of the population aged 25 to 44 is well below average while people aged 45+ are over-represented.

Benalla attractions include: Winton Motor Raceway, Winton Wetlands, State Gliding Centre (Benalla Airport), Benalla Street Art Wall to Wall Festival which is very popular, Silo Wall Art, Benalla Art Gallery and don’t forget the Ned Kelly trail with Ned Kelly history! Benalla Rural City offers a lifestyle that has a choice of primary and secondary schools, a TAFE college, comprehensive health services and a wealth of participation opportunities including theatre sport, music, wine and art. Lake Benalla, with the surrounding Botanical Gardens with beautiful roses (as it is known to be Benalla: the rose city) and walking track, is a key attraction located within the town. Benalla Rural City has a well-developed disability, aged care and childcare services. Since there is a larger proportion of the elderly population, Benalla is considered to be a great place for older people to live and retire. Maintain adequate services, facilities and the workforce to support.

The percentage of people with food insecurity is among the lowest in the state. The rate of family violence incidents per 1,000 population is well above average. A higher than average percentage of people consider Benalla to be an active community as the subject wellbeing plays a huge role and varies between communities. The percentage of people 19 years old having completed year 12 is among the lowest in the state. The percentages of year 9 students attaining national minimum standards in literacy and numeracy are both higher than average.

It was found that in Victoria the Aboriginals were significantly at a higher risk of depression and anxiety, cancer, stroke and asthma and more likely to smoke, not eat enough fruit, drink alcohol and be obese if they resided in rural Victoria. 18% of the Aboriginals had experienced food insecurity compared to 5% in non-Aboriginal Victorians. It was also found that Benalla had a high obesity rate of 26.9 %, cardiovascular diseases such as ischemic heart disease, hypertension and dyslipidaemia, that 5.1% of the population had type 2 diabetes, a higher than the state average in lung cancer and chronic respiratory disease (COPD & asthma). Due to a high amount of the elderly in Benalla, there is a high amount of people that have some range of dementia and mental illness. In the younger population, there was a higher amount of substance abuse and accident/injury than the state average.

My impression of Benalla is that most people are happy to live there and are very engaging with the community. However, a lot of the time I did feel as if I was the youngest person on the street and made me wonder about staff retention in the health department. I think it must be a challenge to retain young health care staff as Benalla is a retirement city with a significant ageing population. This becomes difficult for young families to move in and stay permanently. Hence, a lot of families would reside in other towns surrounding Benalla such as Wangaratta and Shepperton.

A perfect example of the Australian College of Rural and Remote Medicine (ACRRM) and what it represents in Benalla is that all the general practitioners had some sort of subspecialty and top of being a general practitioner specialist. I have seen a general practitioner practice anaesthesia in the morning and do obstetrics as well as dermatology in the afternoon. Something a general practitioner could never do in a city such as Melbourne. The scope of practice for a general practitioner in a rural town is much wider. I have also noticed how the local general practitioners rely on each other to do ward rounds at the hospital and take turns to be on the ‘on-call duties’ as there isn’t a permanent doctor at the Benalla health due to the Australian criteria. This wider scope of practice and relying on colleagues shows how rural medicine is done in Australia.

In Benalla, there is a program called the Parents Early Education Partnership (PEEP) where it aims to make the children ready for their education at school. This program simulates plenty of activities helping the children to listen, understand instruction, follow an order, sing, behave, awareness and generally increasing their development and their skills that will resonate throughout the children’s lives. It targets the Australian Early Development Census which I believe that a child that is more developed in their earlier life will have a better and healthier lifestyle and outcome in life, hence preventing several disease risk. What is remarkable is that children who come from a disadvantageous background can grow and develop with their parents as parents have to attend. The group contains parents from all backgrounds which is proven effective as disadvantaged parents look up to other parents and also develops themselves as parents.

Benalla has been doing considerably well, through the Australian Early Development Census, where programs like PEEP under the umbrella of Tomorrow Today are making a positive change to the community. Although it is important to note that PEEP is not the sole reason for this but is making a contribution. Even though Benalla is under the state average there has been an increase in physical health and wellbeing, social competence, emotional maturity, language and cognitive skills and communication skills and general knowledge (AEDC, 2018). This was noted between 2012 to 2018.

PEEP helps any children that are not on-par with their milestone progression and guides them towards developing themselves by using various methods. Unfortunately, in Benalla, the percentage of people 19 years old having completed year 12 is among the lowest in the state however the percentages of year 9 students attaining national minimum standards in literacy and numeracy are both higher than average (ABS, 2011; VSC, 2015). Compared to Victoria Benalla has a very low SES (VSG, 2015; IC 2016) with the teenage fertility rate being higher than the state measure (BRC,2018). The rate of family violence incidents per 1,000 population is also well above average (VSG, 2015). Hence, having a program like PEEP and other associated programs that goes under Tomorrow Today can really help the growing and development of children where they can be better educated and make a more proactive lifestyle choice. Although this is an extremely difficult task to do as the SES in Benalla is ranked as very low which has many factors on a child and how it will grow and develop as an adult which generally poor.

My interest in rural life and rural medical practice has definitely been consolidated after spending my placement at Benalla Health Hospital in Victoria. I have learnt that general practitioners (GPs) have a huge and meaningful impact on the community and, comically, are celebrities around the town. Knowing almost everyone in the town makes confidentiality a big deal as a small and vague description can easily be traced back to a patient which could have a huge and detrimental impact. The GPs rely on each other to share the workload such as ward rounds and on-call duties at the hospital which demonstrates that a general practitioner in a rural town has more responsibility than I expected. This would definitely apply to the rural ‘extra workload’ factor which is a factor for staff retention. Luckily it was divided by at least 10 doctors meaning the duties were done once a fortnight. I have noticed that most GPs had a subspecialty that they have done through the Australian College of Rural and Remote Medicine (ACRRM) or other agencies and showed me that a general practitioner had a much bigger and wider scope of practice. I find that very interesting and is something I am considering doing and when I spoke to the GPs, they all were passionate about what they do and were aware of their impact on the community. However, I did notice the challenge of retaining staff in Benalla, especially for young doctors and for young families to move into the town as Benalla has a large ageing population. Hence, to meet other people with similar age groups and interest seemed difficult. Staff retention seemed to be a challenge in Benalla and I think that is a huge factor in a rural town to practice medicine, however, the staff that I spoke to were passionate, extremely competent and happy to practise rural medicine.

Clinical activities and clinical skills

Performed normal hand hygiene.
Shadowed nurse on the acute and urgent ward.
Shadowed social worker. It was very interesting to understand the possible support that is available after a patient leaves the hospital such as the My Age Care and National Disability Insurance Scheme.
Shadowed the general practitioner and seen excisions of basal and squamous cell carcinoma.
Day activities program where I spent a whole day with geriatric patients and learning more what is available for them such as support groups.
Theatre operation rooms shadowing: vasectomy, cataracts, Caesar section delivery, removal of miscarriages and excisions of basal cell carcinoma, squamous cell carcinoma and lipoma.
Physiotherapy group consultation and helping out patients doing certain exercise.
Occupational therapy shadowing and understanding their role as an allied health care professional.
Occupational therapy shadowing at the children’s school where I helped kids with their visual, spacing orientations, senses, speech and writing skills.
Dietician consultation and understanding their role as an allied health care and the impact they have on diabetes, celiac, anorexia and geriatric patients.
District Nursing shadowing and going around Benalla to patient’s homes and treat them there. This mainly included wound caring and insulin injections to geriatric patients.
Attended lecture on domestic violence and the role of the health care staff, skincare for the elderly and wound cleaning.
Spent a day at the hospital pharmacy and understanding medication management and delivery as well as pharmaceutical care.
Ward rounds with the GP on call.
Cleaned patient beds and understanding on how to operate the intravenous line machines and its delivery.
Insertion of a catheter into a male patient (O).
Removal of Peripherally Inserted Central Catheter (PICC) lines (O).
Cannulated a patient (O, P).
Taken patient full history, writing it down and investigations (O, P and independently).
Taken observations: temperature, heart rate, respiration rate, blood pressure, oxygen saturation, pain scale, orientation, Glasgow coma scale (O, P and then independently).
Exercise ECG placements on patients by introducing myself, explaining to the patient, putting on the ECG leads and speculating its pathology through the interpretation of the ECG sheet (O, P and then independently).
Performed wound cleaning (P and independently).
Taken blood glucose and given insulin injections (P and independently).
Handovers of patient information to the new staff (P).
Handovers of patient information to the doctor through the phone and asking for further investigations for the patient (P).
Given vaccine injections (P).
Cardiovascular exam (P).
Respiratory exam (P).
Basic neurological exam.

Social or community participation

Attended Parkinson support group.
Benalla museum and art gallery.
Benalla street arts.
Benalla silo arts.
Ned Kelly trail.
Carer support group (a support group that helps carer who look after people who are affected by dementia).
Watched the local Benalla AFL games.
NAIDOC barbecue lunch, celebrating the Aboriginal and Torres Strait Islander’s culture.
Parents Early Educations Program (PEEP) program.
Started the Massive Open Online Course (MOOC) program on Understanding Dementia.

Published 20th August 2019. Last reviewed 1st December 2021.

Reference

Australian Bureau Statistics. 2011 Census Community Profiles - Benalla. Australian Bureau Statistics website. https://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2011/communityprofile/SSC20115?opendocument&navpos=220%20LGA%20Profiles%202015. Published 2011. Accessed April 17th, 2019.

Australian Bureau Statistics. 2016 Census QuickStats. Australian Bureau Statistics website. https://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/2?opendocument. Updated December 13th, 2018. Accessed April 17th, 2019.

Australian Bureau Statistics. Benalla (RC) (LGA) (21010). Australian Bureau Statistics website. https://itt.abs.gov.au/itt/r.jsp?RegionSummary&region=21010&dataset=ABS_REGIONAL_LGA2017&geoconcept=LGA_2017&maplayerid=LGA2017&measure=MEASURE&datasetASGS=ABS_REGIONAL_ASGS2016&datasetLGA=ABS_REGIONAL_LGA2017&regionLGA=LGA_2017&regionASGS=ASGS_2016. Updated November 9th, 2018. Accessed April 17th, 2019.

Australian Bureau Statistics. Life expectancy gender gap narrows. Australian Bureau Statistics website. https://www.abs.gov.au/ausstats/abs@.nsf/latestProducts/3302.0.55.001Media%20Release12015-2017. Updated October 30, 2018. Accessed April 17th, 2019.

Australian Early Development Census. Benalla community. Australian Early Development Census website. https://www.aedc.gov.au/data/data-explorer?id=135261. Published 2018. Accessed April 17th, 2019.

Australian Government Department of Health. Modified Monash Model (2015). DoctorConnect. http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/locator. Published 2015. Accessed April 17th, 2019.

Australian Government Department of Health. ASGS remoteness areas (2016). DoctorConnect. http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/locator. Published 2016. Accessed April 17th, 2019.

Benalla Health. Health Services. Benalla Health website. http://www.benallahealth.org.au/. Accessed April 26th, 2019.

Benalla Rural City. Council Plan 2017-2021 (2018 Review). http://www.benalla.vic.gov.au/Your-Council/Strategies-Plans-Policies/Council-Plan-2017-2021-2018-Review. Published 2018. Accessed April 17th, 2019.

Enjoy Benalla. Benalla Aviation Museum. Enjoy Benalla website. https://www.enjoybenalla.com.au/listing/benalla-aviation-museum-benalla/. Accessed April 16th, 2019.

Enjoy Benalla. History and Heritage. Enjoy Benalla website. https://www.enjoybenalla.com.au/things-to-do/history-and-heritage/. Accessed April 16th, 2019.

Enjoy Benalla. Visit Benalla Tours. Enjoy Benalla website. https://www.enjoybenalla.com.au/listing/visit-benalla-tours-benalla/. Accessed April 16th, 2019.

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