Adapting to rural communities by overseas-born health professionals

Introduction
As with other multicultural nations, cultural diversity is a prominent feature of Australian society that leads to intercultural awareness and respect through citizen interactions. While this enriching multicultural interaction is clearly seen in big cities like Sydney and Melbourne, it can be very different in the Australian rural context. Living in an isolated rural area is challenging for health professionals who were brought up in urban areas, particularly those born overseas as they experience two types of cultural and social adaptation: urban into rural and native culture into new culture.

As a result of workforce shortages, many overseas trained health professionals are recruited to work in Australia, particularly in rural areas. This has given rise to various initiatives and strategies developed to support and assist these health professionals in their dual cultural and social adaptation. These include University Departments of Rural Health and Rural Clinical Schools programs as well as the Rural Workforce Agencies. However, these programs do not extend to those health professionals who were born overseas and trained in Australia as they are ‘Australian graduates’. In this paper we argue that in ways similar to those born and trained overseas, overseas-born Australian-trained health professionals may require additional support during the acculturation process and making the transition to working in rural communities.

Aim
The aim of this study is to examine some aspects of the acculturation of overseas-born Australian trained health professionals working in rural areas. This study seeks to understand the particular issues that emerge as a result of cultural difference in order to propose strategies that may more adequately prepare these Australian graduates for their rural health experience.

Method
Six overseas-born Australian-trained health professionals were invited to participate in this qualitative study using snowball sampling. The interviews were recorded with the approval of the participants. The interview data were transcribed as raw data and later coded for thematic analysis, which includes topics and themes arising from the raw data as well as from the interview questions with a focus on issues and strategies of acculturation into a rural health context.

Results/conclusion
There were different factors which facilitated or hindered the acculturation of overseas-born health professionals into a rural workforce such as professional isolation, cultural shock, family pressure, and cultural identity. The acculturation process was also affected by the quality of their perceived ‘social and cultural capital’. Different coping strategies were employed to deal with the changes in a new rural environment. The paper discusses some implications of this study with focus on how to improve the living and working conditions of overseas-born Australian-trained health professionals in order to attract them to rural Australia.

Our health in our hands : building effective community partnerships for rural health service provision

This paper reports findings from a study in two small Tasmanian rural communities that examined the process of developing and sustaining partnerships between health services and their communities. It identifies a generic framework for partnership development that appears to be common to partnerships, regardless of their purpose or of partners involved. The framework comprises ten predictors or indicators of effectiveness, and a sequential nine-stage partnership development process. Integral to the framework are social capital, and the leadership practices of health service and community leaders. The influence of context on the partnership development process is also examined, with reference to historical precedent, age or maturity of the partnership, and community readiness.

Vietnamese-born health professionals : negotiating work and life in rural Australia

Introduction: Australia is a culturally diverse nation due to migrants from a wide variety of countries creating a multicultural society. The health professions are highly valued by the younger generation of overseas-born migrants who have acculturated into Australian society; many have chosen health care as their profession in Australia. However, most migrants settle in metropolitan areas and young health professionals may find working in rural or remote Australia culturally and professionally highly challenging. The present study of migrant health professionals examined the life experiences and acculturation strategies of Vietnamese-born health professionals working and living in rural Australia. Objectives: The two main study objectives were to: (1) examine aspects of the acculturation of overseas-born and Australian-trained health professionals in the Australian health discourse; and (2) identify key coping strategies used by them when in working in the rural context.

Methods: Six overseas-born, Australian-trained health professionals were invited to participate in this qualitative study using a snowball sampling technique. The participants were all born in Vietnam and had experienced working in rural Australia. They included three medical doctors, a dentist, a physiotherapist and a nurse. The interviews were recorded and four participants also provided additional written responses to some of the open-ended interview questions. The interview data were transcribed and later coded for thematic analysis. Topics and themes that emerged focused on the issues and strategies of acculturation to the rural health context.

Results: The study showed that the acculturation process was affected by the participants’ views about and attitudes towards working in an Australian rural context. The study identified these essential strategies used by the participants in adapting to a new workplace: collaborating, distancing, adjusting, repairing, and accommodating.

Conclusion: The study provides insights into the lives of these health professionals in a rural context, and particularly their experience of cultural shock and the coping strategies they may use. A need is identified for a larger study to inform recruitment and retention of these health professionals to rural Australia, and to assist universities to prepare such students and their clinical supervisors for rural placements.

An `upside-down` view of rural health care

Access to high quality health care services plays an important part in the health of rural communities and individuals. This fact is reflected in efforts by governments to improve the quality of such services through better targeting of funds and more efficient management of services. In Australia, the difficulties experienced by rural communities in attracting and retaining doctors has long been recognized as a contributing factor to the relatively higher levels of morbidity and mortality in rural areas. However, this paper, based on a study of two small rural communities in Australia, suggests that resolving the health problems of rural communities will require more than simply increasing the quality and accessibility of health services. Health and well-being in such communities relates as much to the sense of community cohesion as it does to the direct provision of medical services. Over recent years, that cohesion has diminished, undermined in part by government policies that have fuelled an exodus from small rural communities to urban areas. Until governments begin to take an 'upside-down' perspective, focusing on building healthy communities rather than simply on building hospitals to make communities healthy, the disadvantages faced by rural people will continue to be exacerbated.

Building capacity for rural health : the role of boundary crossers in coalition maturity for partnerships with external agents

The concept of partnership has entered policy rhetoric and is urged as good practice in a variety of domains including health. Rural communities tend to have fewer resources available for the provision of services such as health than their metropolitan counterparts, and so could be expected to benefit from partnerships with external agencies. Indicators of coalition maturity for working in partnership with external agents in order to build stronger communities are distilled from the group development and partnership research literature and considered in the light of the experiences of the University Department of Rural Health in community engagement. The chapter draws on experiences of two rural community coalitions working to plan and negotiate health service provision. The coalitions were analysed against the indicators. A key indicator of maturity and readiness for working in partnership with external agents is related to the behaviour of ‘boundary crossers’. Boundary crossers are defined as people who move freely between two or more domains and who understand the values, cultures and language, and have the trust, of both. Domains can be within a community or be the community and an external sector. Community health professionals, especially those in senior positions, often act as boundary crossers between the community and broader domains such as regional/state health services or policy, although other community members can fill the role. Other key indicators of coalition maturity for working in partnership with external agents include local leadership that empowers the community, a willingness of community coalitions to take risks and mould opportunities to meet their vision, and a culture of critical reflection and evaluation of past actions.

This chapter analyses the impact of boundary crossing behaviour on community readiness and partnerships with external agents that are intended to build rural community capacity to plan and negotiate health service provision. It is argued that the characteristics and modus operandi of boundary crossers who are members of rural community coalitions affect the level of maturity of the coalitions and community readiness to work with external agents. An understanding of the characteristics and modus operandi of boundary crossers provides valuable insights for external agents in designing their approach to partnerships that build rural community capacity for health.

Building capacity for rural health : the role of boundary crosser and the impact of their behaviours on community readiness partnerships

The concept of partnership has entered policy rhetoric and is urged as good practice in a variety of domains including health. Rural communities tend to have fewer resources available for the provision of services such as health than their metropolitan counterparts, and so could be expected to benefit from partnerships with external agencies. Indicators of coalition maturity for working in partnership with external agents in order to build stronger communities are distilled from the group development and partnership research literature and considered in the light of the experiences of the University Department of Rural Health in community engagement. The chapter draws on experiences of two rural community coalitions working to plan and negotiate health service provision. The coalitions were analysed against the indicators. A key indicator of maturity and readiness for working in partnership with external agents is related to the behaviour of ‘boundary crossers’. Boundary crossers are defined as people who move freely between two or more domains and who understand the values, cultures and language, and have the trust, of both. Domains can be within a community or be the community and an external sector. Community health professionals, especially those in senior positions, often act as boundary crossers between the community and broader domains such as regional/state health services or policy, although other community members can fill the role. Other key indicators of coalition maturity for working in partnership with external agents include local leadership that empowers the community, a willingness of community coalitions to take risks and mould opportunities to meet their vision, and a culture of critical reflection and evaluation of past actions.

This chapter analyses the impact of boundary crossing behaviour on community readiness and partnerships with external agents that are intended to build rural community capacity to plan and negotiate health service provision. It is argued that the characteristics and modus operandi of boundary crossers who are members of rural community coalitions affect the level of maturity of the coalitions and community readiness to work with external agents. An understanding of the characteristics and modus operandi of boundary crossers provides valuable insights for external agents in designing their approach to partnerships that build rural community capacity for health.

Rural Health Week Tasmania 2007

Aims & Rationale/Objectives
To raise the awareness of health issues in rural Tasmania, the work of rural health professionals and community volunteers

Methods
A partnership initiative between the University Department of Rural Health and the Department of Health and Human Services attracted $64,000 sponsorship from government and private sector. It established 28 regional groups which organised local activities and awards for a community volunteeer and a health professional. Regional groups were surveyed about their planning process for rural health week, the activities held, their outcomes and future intentions.

Principal Findings
Regional groups were partnerships of local organisations. Activities had a preventative focus. They included cooking, bike rides, dances, manual handling, health checks, community art, suicide prevention.Events attracted up to 300 participants. There were 48 nominations for the 2 awards, which were perceived to have raised the profile of health professionals and volunteers. Activities that attracted most participation were fun runs and health expos. Most used their understanding of community needs when deciding on activities. Only a small number relied on formal health needs analyses. Groups varied in their assessment of how well the activities they organised actually met needs. Half the group members had not worked together previously. All but 3 intend to work with others in the future. Most group members learnt more about health programs and other professionals in their community.

Implications
Raised profile of health services and role of health professionals and volunteers in rural Tasmania.
Increased range of ongoing health promoting activities. Better planned and coordinated activities.

Having a baby in the new land : a qualitative exploration of the experiences of Asian migrants in rural Tasmania, Australia

Introduction: Australia is a land of cultural diversity. Cultural differences in maternity care may result in conflict between migrants and healthcare providers, especially when migrants have minimal English language knowledge. The aim of the study was to investigate Asian migrant women’s child-birth experiences in a rural Australian context.

Method: The study consisted of semi-structured interviews conducted with 10 Asian migrant women living in rural Tasmania to explore their childbirth experiences and the barriers they faced in accessing maternal care in the new land. The data were analysed using grounded theory and three main categories were identified: ‘migrants with traditional practices in the new land’, ‘support and postnatal experiences’ and ‘barriers to accessing maternal care’.

Results: The findings revealed that Asian migrants in Tasmania faced language and cultural barriers when dealing with the new healthcare system. Because some Asian migrants retain traditional views and practices for maternity care, confusion and conflicting expectations may occur. Family and community play an important role in supporting migrant women through their maternity care.

Conclusions: Providing interpreting services, social support for migrant women and improving the cross-cultural training for healthcare providers were recommended to improve available maternal care services.

Boundary crossers, communities, and health : exploring the role of rural health professionals

Boundary crossers understand the culture and language of community and health service domains and have the trust of both. Rural health professionals living within the communities they serve are ideally placed to harness community capacity so as to influence community-level determinants of health. We analyse five case studies of rural health professionals acting as boundary crossers against indicators of capacity for communities and external agents such as health services working in partnership. A more explicit evidence base for inclusion of community health development in the jobs of rural health professionals is needed.

Are rural health professionals also social entrepreneurs?

Social entrepreneurs formally or informally generate community associations and networking that produces social outcomes. Social entrepreneurship is a relatively new and poorly understood concept. Policy promotes generating community activity, particularly in rural areas, for health and social benefits and ‘community resilience’. Rural health professionals might be well placed to generate community activity due to their status and networks. This exploratory study, conducted in rural Tasmania and the Highlands and Islands of Scotland considered whether rural health professionals act as social entrepreneurs. We investigated activities generated and processes of production. Thirty-eight interviews were conducted with general practitioners, community nurses, primary healthcare managers and allied health professionals living and working rurally. Interviewees were self-selecting responders to an invitation for rural health professionals who were ‘formally or informally generating community associations or networking that produced social outcomes’. We found that rural health professionals initiated many community activities with social outcomes, most related to health. Their identification of opportunities related to knowledge of health needs and examples of initiatives seen elsewhere. Health professionals described ready access to useful people and financial resources. In building activities, health professionals could simultaneously utilise skills and knowledge from professional, community member and personal dimensions. Outcomes included social and health benefits, personal ‘buzz’ and community capacity. Health professionals' actions could be described as social entrepreneurship: identifying opportunities, utilising resources and making ‘deals’. They also align with community development. Health professionals use contextual knowledge to envisage and grow activities, indicating that, as social entrepreneurs, they do not explicitly choose a social mission, rather they act within their known world-view. Policymakers could consider ways to engage rural health professionals as social entrepreneurs, in helping to produce resilient communities.