Rural & Regional Health: “I’m not lost!”

A blog from Bodø, Norway. The regional capital of Nordland…  a town of about 52,000 people… just north of the arctic circle… the land of the midnight sun.  I am here to speak at a European Mental Health Conference… it is a regional town… out of the way, hard-ish to get to…

I was talking with a nursing colleague yesterday. She was stunned to find that an Australian had travelled all the way to attend the conference – about 37 hours of travel…

She asked… Was I lost? Why was I here? As a university academic surely I was in the wrong place?

we talked…

I said… No, I am in just the right place… 

You see, I am a rural and regional person, from birth to present day. My career has been dotted around  regional and rural communities across Eastern Australia and regional Denmark, so far… I understand rural and regional communities – from the inside out. I love them. I am most at home in them. I know what makes them ‘tick’. I know what ails them. I know when they are in pain, and distressed. I care about the people, and their health and well-being opportunities, most particularly.

At the beginning of my career, I set about attempting to make things better for rural and regional people… starting out small, learning my craft – working with individuals and small groups… providing rural and regional nursing care to people – often stretching my scope of knowledge and practice to the edge of capability, and sometimes, by necessity beyond…  Rural nurses eventually acquire specialist generalist skills – because we look after every problem that presents for the human condition… and we learn to cope! It gives us a unique skill set and expertise… not easily achieved in urban settings with more discreet silos of expertise…

Later, I  was able to study more, and learnt to scale my nursing skills and expertise to contribute towards making things better for communities in national and international settings. Somehow… in a convoluted way… it has become what I do! My agricultural worker father (retired) still can’t get his head around it all and has been known to suggest that life might have been easier if I have stayed working in country town retail instead! (He is proud of me… but wonders what it is that I actually do! To him, a nurse is at the bedside… Teaching and creating the evidence on which nurses today base their practice is less of a job to his mind! But, as he receives nursing care, he is especially proud to be nursed by some of the nurses that I have taught… and I am glad that he is the recipient of ‘my nurses’ care too!) So, my rural and regional roots continue to infiltrate what I do, and how I see the world… it frames my contributions to health disciplines, and to nursing specifically.

I contribute to rural and regional health…

I do this through playing my part in educating nursing and other health professionals to care for others… 1000’s of nurses now have passed through my classrooms.

I do this through scientific investigation. Researching the triggers of distress in people’s lives and contributing evidence to help build solutions for improving the health care of rural and regional people – in hard to reach places… all over the world. Hundreds of others have cited my publications… journals, textbooks, articles, presentations….

I do this through teaching others to conduct scientific investigation…

I do this through using my accumulated scientific and clinical knowledge to advocate for the health and well-being needs of others.

I do this in many other ways too… but for the sake of brevity… I stop the list here!

So, naturally, it is a priority…when I communicate the findings of my research, I take it back to the regions... I remain curious and connected with the regions, and to rural people generally. It is where I fit in… and where my science and practice fit in…

Major capital cities and big urban conferences – they all have a place, and, I have learnt to speak up in these forums too, in advocacy for rural and regional communities. But, when it comes to being in the right place, and  communicating with the right people… for me, they are often located in the hardest to reach, most inconvenient places on the globe. That is the right place for me, and this is where I consider that I can make the most impactful and meaningful contributions to society, although be it small, it is significant. It is not the same as urban-based academic impact and meaning… but it is, most often, the most relevant audience for my work. Notably, in stark contrast to the usual connotations of impact and meaning in the academic world… driven by big conferences, with big followings, big consortiums and big funders…big impact factors… huge H indexes… But, me…  My influence is more particular… it might be less prominent on the world stage perhaps… (all a matter of perspective and biased privileged metrics really). My work is aligned with relevance to the people and places where it makes the most sense. It fits just right!

It is not the dream for everyone… I get that (actually kinda don’t get that!). It is not likely that I will never be the most popular mental health researcher… in demand for keynotes across the capital cities of the world…  I won’t achieve the biggest impact in my nursing discipline, I won’t win the biggest grants – with the ‘in-crowd’ collaborators, I won’t have the biggest most eminent teams…they are not my goals… My rural and regional sentimentality is not always welcomed by the high-flyers based in powerful and ivory research consortiums… sometimes it is even shunned. But, I am confident beyond and I do play my part in furthering mental health knowledge. There was a time when I thought that being a rural and regional nurse was a ‘less than’ value to that of a urban counterpart nurse…Now I see it as a highly prized badge of achievement, as a unique honour that does not come easily won. I am in a minority subset, and inclusion at the main table is often hard fought, and tokenistic… You probably won’t find me at the world’s most prestigious hospitals and universities… But, you will find me at the smaller, less well resourced institutions… out of the way, and off the main strip… But, I know who I am am and what I am doing! I am a rural and regional insider… a health researcher. Advocating for rural and regional fair share of health budgets and resources… for service access and delivery… and contributing scientific evidence to support my advocacy… there are others like me… but we are relatively few! All doing our bit… the world needs us.

Rural and regional people make up about 45% of the world population – by 2050… according to the United Nations 68% of  people will live in urban populations. In Australia, currently about 1/3 of the population live in rural and regional areas… There are implications for access to services… including health services. Rural and regional people make significant contributions to society… we grow food, and provide services and commodities to world markets… the health and well being of rural populations is a critical aspect of country health and sustained economic viability… and then there are human rights to consider too. Yet, the health and well-being of rural and regional people is generally poorer than urban counterparts. This all matters…

So, why am I tucked away in a regional town, so far from home… ? …discussing the mental health needs of hard to reach populations? Because global rural and regional health matters… and, it is what I have spent a great deal of time and dedication learning about, and this meeting in Bodø, in out-of-the-way, Norway is a particular opportunity to meet with other experts and to discuss and share news about how to help regional people with mental health needs best.

Is it worthwhile… ? Yes! Am I am in the wrong place? No, absolutely not!

I am right where I should be, in the regions, representing regions as an authentic insider… participating in the development of mental health knowledge for the benefit of enhancing health services for hard to reach populations. 

So – to my well meaning nursing colleague who asked if I am lost? No, I’m not lost!  I do, however, recognise that I am incredibly privileged to see and visit the exquisite regions of the world… outside of the major cities… working towards making things better for rural and regional peoples…  just how I like it, and just where I fit in the scheme of things.



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