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From a broom cupboard: 20 years of rural health at Monash University

Ch 02. Changing emphasis

Monash University Department of Rural and Indigenous Health

The vision and key objectives of the Centre for Rural Health and the School of Rural Health have remained relatively constant over the last 20 years. The organisation has always been involved with medical education, including undergraduate, postgraduate and vocational training; academic and project research, and consultancy; rural development projects concentrating on connecting with rural communities; and workforce issues. The amount of time, money and effort spent on the various activity streams has varied significantly from one time to another, depending on funding, available expertise and opportunity.

Originally the centre’s work was mainly undergraduate medical education. Although this activity continued, during the 1990s vocational training programs for general practitioners as well as research, community projects and consultancies comprised an increasing proportion of the organisation’s output. At this time, the centre’s workforce contained an eclectic mix of general practitioners and clinical teachers, other health professionals and sociologists. In the early 2000s elevation from centre to school status, development of Monash University’s five-year medical curriculum, the introduction of the Commonwealth Government’s Rural Clinical School Program and the subsequent establishment of the four regional clinical schools saw the primary focus return to undergraduate medical education. The burst of effort required to overcome this medical education hiatus was followed by many non-medically trained staff returning to their professional roots. The end result was the establishment of the Centre for Multi-Disciplinary Studies in Rural Health and later recognition of this centre as a bona fide university department of rural health: the Monash University Department of Rural and Indigenous Health.

Much is written elsewhere in this book of medical education and research. Here we look at the other streams of activity and the establishment of the Centre for Multi-Disciplinary Studies in Rural Health and Monash University Department of Rural and Indigenous Health. These other aspects of rural health, outside the mainstream academic disciplines, have been critical in the evolution of the school and fundamental to its culture. In many respects the activities in the Centre for Rural Health in the mid-1990s are most closely reflected in the activities of the University Department of Rural and Indigenous Health today.

A multidisciplinary focus

Professor Elaine Duffy

My first recollection of the Centre for Rural Health was July 1995 when I drove to Moe from Frankston to discuss with the renowned Professor Roger Strasser the potential for a one-year secondment to the centre from the then sub-faculty of Nursing. I thought that although the centre was young it was extremely vibrant and had unlimited potential to become a unique rural research and education centre within the medical faculty.

I found the centre physically small but the environment was full of energy, excitement and laughter blended with serious politics, academic work and critical scholarship. The place was buzzing despite the small space and the relatively small team. I had a great discussion with Roger and he agreed to my secondment to the centre for initially one year. As it turned out, I was at the centre for eight years. My time there was the most productive of my career in terms of successful grant writing, research performance, publications, conference presentations and professional involvement, thanks to the support provided to me by the staff and especially the mentoring I received from Roger. He was inspiring, creative, committed, energetic and a supreme champion for rural health. His political acumen was, and still is, outstanding.

The reputation of the centre, particularly in terms of rural research, was impressive. I was keen to develop rural nursing research and education as there had been minimal nursing contribution up to this point. The centre was expanding rapidly and achieved tremendous results by highlighting issues to rural health stakeholders, funding bodies and policy makers at local, state, national and international levels. At this time, rural health was a highly politicised priority for national and state governments. Under Roger’s leadership the centre made the most of these opportunities, churning out submissions for projects and crucial project funding. It was exciting to be welcomed as part of this team.

In December 1996, after five years of extensive growth in budget, staff and function, a facilitated review planning workshop was held. A small group, to which Jo Wainer, Jane Greacen, Elaine Evans, Robert Hall and I belonged, was assigned the task of continuing the redevelopment process. The group was known as the group for organisational overview and development – the GOODies. We worked and played very well together. Robert Hall stimulated the team to think creatively with his astonishingly expansive and creative intellect. The result for the Centre for Rural Health was a three-dimensional matrix model that became the template for the future organisation. Before we implemented the new organisational structure, discussions in the faculty and the university were pointing toward the centre becoming the School of Rural Health, which it did in 2002.

The GOODies working on their strategic report 1997: left to right – Elaine Duffy, Robert Hall, Jo Wainer, Jane Greacen, Elaine Evans.

Though I represented the nursing discipline, a great number of projects and initiatives with which I was involved were multidisciplinary in nature. One of the more important initiatives in nursing, working in conjunction with the Monash School of Nursing at Churchill campus, was the development of a double degree in nursing and rural practice. The double degree was the result of national research that examined rural nursing practice and education. The project was undertaken in collaboration with Lesley Siegloff, a senior lecturer at La Trobe University at that time, and Mollie Burley. Mollie brought to the centre excellent skills in rural nursing, education and research.

Following 12 months of negotiations with and submissions to the Commonwealth Government, the Centre for Multi-Disciplinary Studies in Rural Health was established. This centre aimed to expand rural nursing and allied health education research, and to focus on Aboriginal health issues. The centre later became the Monash University Department of Rural and Indigenous Health. I worked with so many memorable characters at the Centre for Rural Health, but I would particularly like to acknowledge the work of Lexia Bryant, David Campbell, Peter O’Meara, Debra Cerasa, Anske Robinson and Matthew McGrail. My experience at the Centre for Rural Health was memorable, intellectually stimulating, challenging and great fun. It is one of the highlights of my career.

A wild idea in Gippsland

Professor Peter O’Meara

My first association with the then Centre for Rural Health was in the mid-1990s in my role as a general manager in the Gippsland ambulance service. Contact had been made with Professor Roger Strasser to determine whether the Centre for Rural Health could help us recruit and retain ambulance service medical officers in the Gippsland region. Roger jumped at the opportunity to create a new role and to attract some sustainable income to the fledgling academic unit. This arrangement to provide medical officers persisted for a number of years until the absorption of rural and regional ambulance services into Ambulance Victoria.

Following an ambulance service restructure, I found myself at the centre as a part-time staff member undertaking a feasibility study on the establishment of an after-hours medical service in Moe following the closure of the local hospital. Both Roger Strasser and Dr Robert Hall were my key mentors on this study as I started my career transition from clinician/manager to academic. Like many of the early staff at the centre I found myself undertaking a wide range of administrative, teaching and research activities. One of my early and most challenging assignments was to present the findings of a large research study concerning GP recruitment and retention at a rural health conference in Wagga Wagga. I was also interviewed on live regional radio within my first month of employment. I was quickly to discover that leaving my comfort zone would be a regular experience at the centre.

While the centre at that time was within the family of Monash University’s Department of Community Medicine, there appeared to be a high degree of actual or implied autonomy from university policies and procedures. There existed a strong ‘can do’ culture that encouraged all staff to follow ideas and potential funding sources. Roger Strasser was particularly good at promoting our work and obtaining funding for projects from all levels of government and organisations that extended our short-term employment contracts for many years. My own involvement with the Moe After Hours Medical Service was sustained for five years from an initial three-month contract.

During the early days the centre consisted of a wide range of individuals drawn from the health professions, teaching, the social sciences and information technology. None of the staff had doctoral qualifications and by today’s standards we were arguably operating on the very edge of our expertise and experience. All staff worked across projects and learnt a wide range of skills from each other. In my own case, I was fortunate to be able to learn many academic and technical skills from full-time staff such as Dean Carson and Steve Kirkbright who were driving forces in the early success of the Centre for Rural Health. Without Steve’s efforts it is doubtful that any reports or promotional materials would ever have been created and followed through to completion. Out of necessity we became pioneers in marketing, interprofessional education, and research.

Over time this sense of collegiality transformed into a more strategic approach to personal and professional development; staff were encouraged and supported to undertake higher degrees, to write scholarly articles to further their own academic careers and to build rural health research capacity. A very successful venture in 2002 was the formation of a rural health writing group, predominately based in Gippsland, which produced strong scholarly outputs and helped launch a number of notable academic careers. The old centre gradually began to morph into a mainstream academic unit of Monash University.

Because of the diverse and dynamic nature of the research and evaluation activities being undertaken within the then School of Rural Health, it was often possible to combine project work with our doctoral and masters studies. I took advantage of this opportunity when I was ‘rescued’ from the role of resources manager to work on the Urgent Care in Small Rural Communities Project with Heather Kelly, Mollie Burley and others. From my perspective, this project was the catalyst for the beginning of my Australian and international academic collaborations.

Because of the limited office options in the new Traralgon building, a group of us found ourselves occupying the same work space where we shared ideas, frustrations, skills and many personal aspects of our lives. This multidisciplinary in-house group consisted of a couple of nurses, a statistician, a historian, a teacher, a paramedic and a library assistant. Others – including Kathy Pendergast and Phillippa Greene from East Gippsland and Janice Chesters, based locally – visited and collaborated with us in a constantly changing set of roles on projects that both challenged and stimulated us. The strength of this extended group was the support and encouragement we provided to each other as we grew and developed as researchers and people. Of that small group of research and writing collaborators at least five now have PhDs – Matthew McGrail, Claire Rickard, Anske Robinson, Rebecca Jones and I – while others completed masters degrees and published widely. Claire Rickard and I are now professors within our own disciplines, while others are making great strides in their ongoing academic careers.

To me, it is the success of these and other groups within the School of Rural Health that point to its predominance as a pioneering rural health academic unit which grew from little more than a rather wild idea in Gippsland.

Gaining recognition

Dr Janice Chesters

The internal business units of large organisations are generally fluid. They are subject to changes in managerial or organisational theory, and to the personalities and belief systems of leaders. Restructure and reorganisation are common, as is the refinement of internal relationships within the unit and of external duties and relationships with the wider organisation and the world. Units are restructured into larger or smaller sections, are joined or separated from larger units, or their reporting lines are changed. Units undertaking new or emerging business or undergoing rapid change are particularly prone to restructure or reorganisation. The School of Rural Health’s change and development is both like every other organisation and yet totally unique and different from other similar groups.

The Monash University Centre for Rural Health was an early adopter of what was to become a major national program of rural health reform. The Department of Health and Ageing suggests that the groundwork for this rural health reform can be traced back to the first National Rural Health Conference held in 1991. The Centre for Rural Health was formed in 1992 and was the first rural health academic unit in Australia. The first major Commonwealth investment in rural health was a provision of the 1996–97 federal budget which funded the establishment of the University Departments of Rural Health Program. The centre was the model for this program; but, significantly, a university department of rural health at Monash was not recognised by the Commonwealth until much later, in 2006.

Why was the Centre for Rural Health not one of the first rural health academic units to receive university department of rural health funding? Many reasons have been offered over the years. They range from a reluctance to see rural Victoria as really rural to the fact that the centre already existed so could perhaps do without funding. Alternative theories involve intrigue and conspiracy, for instance, the thought that someone in power did not like the centre. Yet another possibility was the formation of the Victorian Universities Rural Health Consortium. It commenced in 1998 as a Commonwealth initiative to enhance the provision of education and training for rural and Aboriginal health professionals, as well as rural and Aboriginal workforce development and career planning. Perhaps the intention was to link all the universities involved in rural health into an organisation that was a little like a state-wide university department. The consortium was a troubled organisation and the Victorian Department of Human Services took over funding in 2002 after the Commonwealth withdrew. In turn, Victoria eventually pulled out of funding the consortium.

Funded or not, the Centre for Rural Health was committed to rural workforce development for all health disciplines. This is an important point to make. While the founding leader, Roger Strasser, was a medical doctor, the deputy director was a senior nurse, and staff members came from a variety of health and academic backgrounds. The centre was multidisciplinary from very early in its development. However, it could not be said to act as an interprofessional unit as the disciplines remained fairly firmly within their disciplinary silos. The centre continued to progress without Commonwealth funding, gaining some significant grant support from other sources, but seeing its Master of Rural Health program wax and wane. The centre was an independent unit within a changing faculty and university.

A defining moment for the centre occurred at a faculty meeting held in the lecture theatre – which later became the Strasser Auditorium – at Latrobe Regional Hospital. Most of the centre’s staff was there to hear a presentation by the dean, Professor Nick Saunders, and Professor Chris Browne on the proposed faculty restructure. To us at the Centre for Rural Health it looked as though we were going to be part of a new School of Community Health. The centre, led by Roger Strasser, wanted to stay independent and become a School of Rural Health. At that meeting this looked like a very unlikely outcome. But then what became known as the Rural Clinical Schools Program was announced. This time Monash was among the first universities to be funded. In fact the whole program was formally launched at the brand new Bairnsdale Clinical School.

The Rural Clinical Schools Program was an important, well-funded program that changed the focus of the centre and provided a large enough income stream to justify school status. In 2000 the Centre for Rural Health became the School of Rural Health. The centre had always been involved in medical education but the rural clinical school funding increased the scale of our involvement manyfold. Coincidentally, the faculty was also undertaking a significant restructure of the medical curriculum at that time. Suddenly the majority of the school was involved in planning the medical curriculum right across the new five-year Monash course. From transition camp through to their final year, increasing numbers of Monash medical students were spending learning time in rural places.

The Rural Clinical Schools Program was a major undertaking that became the main game in the new School of Rural Health. This focus became dominant in part because Monash did not receive university department of rural health funding. That funding encouraged a more multidisciplinary focus that had been the dominant culture prior to clinical school funding. In yet another attempt to fund nursing and allied heath work, an application was made for Department of Health and Ageing funding. This time we were partially successful.

The Centre for Multi-Disciplinary Studies in Rural Health was funded by the department in 2002 for three years at $500,000 per annum. While the centre funding was significantly below that provided to university departments of rural health, it was a very significant first step along the pathway to acquiring full status as a university department of rural health. Associate Professor Elaine Duffy was the first director of the Centre for Multi-Disciplinary Studies in Rural Health. The main thrust of this major research and education program came from the Traralgon school hub. However, fractional-time employees were located at all school sites including Bairnsdale, Mildura, and Bendigo. The centre undertook some key projects, one of which seemed to impact significantly on the attitudes of the Department of Health and Ageing toward the Monash School of Rural Health, eventually resulting in its gaining full status as a university department of rural health.

In 2005 the Centre for Multi-Disciplinary Studies in Rural Health’s Indigenous Health Unit won a major Rural Undergraduate Support and Coordination Project of National Significance grant. As project leader, Monash partnered with the University of New South Wales and James Cook University to develop a recruitment model and material for Aboriginal students that could be used and applied by health science faculties across Australia. Led by Marlene Drysdale, what became known as the Footprints Project was very successful and well received by the Department of Health and Ageing. It was during one of many face-to-face reporting visits to Canberra that the questions of full university department of rural health status and, more importantly, funding, were raised.

One key meeting stood out in our minds. We were reporting yet again on Footprints, but were surprised to find an additional person in the room. The person said nothing for much of the meeting. Finally we were told that it was very likely that, should we apply, we would finally become a full university department of rural health. We asked about the time frame within which this would happen, whereupon the previously silent person replied, ‘I suppose that you want it by next Monday.’ We were meeting on a Friday. Although we were unsure of the spirit that this comment was made in, I recall we did say something like ‘That would be great.’

MUDRIH did not start by Monday, but a full application was submitted by the head of school, Professor Geoff Solarsh, in May 2006. By June 2006 we were finally recognised as a full university department of rural health. Funding increased significantly and capital works funding was also made available. MUDRIH was now able to benefit from other national funding programs supporting work in rural pharmacy, mental health and research training. The number of staff grew and new senior roles were filled. This intense growth precipitated a move to the old head of school site in Moe. The Moe building became the fifth major site of the School of Rural Health. A small MUDRIH office at Monash’s Clayton campus was also set up.

The Monash University Department of Rural and Indigenous Health continued to grow in strength between 2006 and 2010. We developed excellence in education – especially in Aboriginal health units – research training and rural placements in pharmacy, nursing, mental health and other allied health disciplines, and strong collaborative links with Latrobe Community Health Service. The team undertook research in a wide range of topics, especially mental health, interprofessional practice, Aboriginal health, and recruitment and retention. A focus on interprofessional practice replaced the more siloed focus on multidisciplinary work. The administrative and technical staff were excellent: they developed and updated the website, databases, student accommodation options, a conference room booking service, and offered high-level support to academic staff.

A gender perspective

Dr Jo Wainer, AM

The road trip to my job interview at the Monash University Centre for Rural Health in Moe was the leap of faith that characterises the first steps of the ‘fool’s journey’. Mystery was everywhere. The university, the centre, Gippsland, academic practice, and Moe were all unknown to me. As I drove along the highway I could feel my links with the familiar shredding. I was interviewed by Professor Roger Strasser and Dr Robert Hall in a scene of mutual incomprehension. I had two Monash medical faculty professors as referees and said I would move to Gippsland. That got me my first university job.

My initial role was modest. I was to take over and complete a study of the health needs of small rural communities. The best part was driving throughout Victoria to interview people in six communities, discovering that each community was different, as were people’s views of health services.

My second task was to complete work for the Commonwealth: to understand how graduating female doctors could be attracted to rural practice. The driver was the shortage of rural doctors combined with the high male ratio in the rural medical workforce and the increasing ratio of graduating female doctors. The question was: what was needed so that women would go into rural practice? This question defined my role with the centre and absorbed me for the next decade.

After I had packed my bags, rented an old farmhouse and moved to Gippsland, I spent my first year at the Churchill campus of Monash University. I then moved to the Centre for Rural Health, based in an old ward at the Moe Hospital. Roger Strasser and his personal assistant, Elaine Evans, were the two full-time members of staff. Academic medical support was provided by GPs Dr Robert Hall and Dr Kaye Birks, and surgeon Mr David Birks. Others were gradually collected to support the work of the centre, which had two purposes: to understand how medical practice in rural environments was affected by those environments and, as a consequence, required specific models of training and care; to understand the drivers for doctors to go into rural practice.

Initially, the team was small enough for corridor conversations to provide a satisfactory organisational model. Roger’s relentless drive to understand the relationship between place (rural) and function (medicine) attracted increasing funding and staff. There was the inevitable crunch when the goodwill model of management no longer worked. Associate Professor Elaine Duffy joined the team and under her guidance the next academic rural practice model was developed.

David Birks and I worked with a team we called the GOODies – the group for the organisational overview and development of the future management structure of the centre. David and I shared a working space, and the surgeon and the social scientist eventually found common ground. We recommended that the ‘all roads lead to Roger’ management practice devolve on to four teams, each with a team leader. I took on the role of team leader for the research team until Professor John Humphreys joined the centre and established the research office at Bendigo.

Early research into why some doctors practise in rural areas suggested that having a rural background and experiencing rural practice as an undergraduate were two key drivers. This was enough to encourage the Commonwealth Government to support medical faculties to include rural practice in their curriculum. Rural practice at the time was believed to be of a lesser standard than metropolitan medicine and of no interest to either the faculty or students. Roger worked tirelessly at faculty level to reverse this assumption, with spectacular success. Academic rural GP, Dr Lexia Bryant, worked out of tiny office spaces for years as the centre’s representative at the faculty office at Clayton. Eventually she secured dedicated office space for the centre which hosted the rural students’ club, visiting rural academics and full-time staff member, Teresa Neale, to coordinate rural requirements for students.

Staff at the centre began to organise placements for medical students with rural general practitioners. The faculty was encouraged, then funded and eventually required by the Commonwealth to provide some training in rural placements to all medical students and much training to some students.

Roger secured funding to build student accommodation and teaching facilities in the new Latrobe Regional Hospital in Traralgon. Rural doctors were recruited to teach and given honorary academic appointments, and the basis for the School of Rural Health was established.

I developed curriculum about women in rural practice as part of the project to encourage female students to consider a career as a rural doctor. This curriculum was taught by local female doctors including Kaye Birks, Jo McCubbin, Heather Hunter, Heather Miller, Sarah Strasser and Gillian Murray. The male medical students were difficult to engage with this topic so I expanded the curriculum into even more novel territory – gender and medicine – and recruited additional rural GPs such as Dr James Brown from Trafalgar to teach it.

I also wrote a proposal to faculty to put rural medicine on its priority list of strategically important research areas. The proposal both increased the profile of rural health research and opened up avenues of support within the faculty.

My major work with the centre and later the School of Rural Health was in understanding the way gender played out among rural doctors and, in particular, how to integrate women into the masculine culture of rural medicine. This was part academic – doing the research to understand what was going on – and part political – encouraging conversation where it mattered and establishing communities of interest. The major academic work was the development of the curriculum about gender and medicine. The work was published by the school as a monograph1 and as a paper and chapter in Women and Health.2

This area was expanded through the work of my colleague, Dr Ann-Maree Nobelius, and included through the whole medical curriculum at Monash. I presented this work as a rural case study to the World Health Organisation forum of experts on gender and medicine in Geneva in 2006. Ann-Maree and I presented papers on teaching gender and medicine at world congresses on Gender Specific Medicine in Berlin and Stockholm. I presented the Monash gender and medicine curriculum at a UN forum3 and as the keynote speaker at the Gender, Health and Medicine Conference in Taiwan in 2010. In 2012 I wrote the foreword and introduction to the international Handbook of Clinical Gender Medicine. So the small project that began as tutorials for medical students at Latrobe Regional Hospital morphed into the international conversation about gender and medicine.

The major research was a national study of rural doctors that explored how being female or male was reflected in satisfaction with rural practice. I found that predictors of years of future rural practice differed for men and women. As a staff member of the school I also undertook studies of female rural doctors and findings were presented to national and international rural conferences, published as monographs and as journal articles.4

I built on these studies to undertake a PhD exploring the relationship between medicine and the feminine. Dr George Somers and I were among the first PhD candidates with the school. Roger Strasser was my supervisor and when he left for Canada I transferred to the Alfred Psychiatry Research Unit, so did not graduate as a candidate from the school, although Dr Somers did.

Jo Wainer and Roger Strasser inspect a footpath pharmacy, most likely during the Wonca Rural Health Conference held in Durban in 2001.

The project of including women in rural practice was actively supported at the centre. Roger was visionary in his strategy of taking many of his staff to national and international conferences. I presented my work about female rural doctors at the World Organization of Family Doctors (Wonca) conferences, including the rural-specific ones, every year from 1998 to 2002. This included my involvement as a keynote speaker at the Calgary conference in Canada at which the Calgary Commitment to women family doctors was passed by the conference.5 Sarah Strasser, Lexia Bryant and I were instrumental in writing that commitment.

My presentation on female rural doctors at the Durban Wonca rural congress in 1998 was the first time the topic had been considered at an international level. We made sure that women were included as both speakers and facilitators at all subsequent Wonca rural congresses, and eventually we developed the Wonca Rural Policy on Female Family Physicians in Rural Practice.6 This was led by Dr Barbara Doty from Canada and was accepted as Wonca policy in 2003.7

Roger also encouraged Lexia Bryant to take on the task of including women in the foundation documents of the Australian College of Rural and Remote Medicine when that college was being formed. Lexia was able to draw on our work about female rural doctors, and subsequently became the chair of the women in rural practice committee that was established by the college; she later became president of the college.

Fostering collaboration

Mollie Burley

When I joined the Centre for Rural Health in 1992, it was a small centre with a strong medical and rural focus, involving researchers from nursing, psychology and education. In the years that followed, the centre changed names, roles and identities and finally became MUDRIH under the umbrella of the School of Rural Health. The roll-out of the Rural Clinical Schools Program changed the face of rural health in Victoria, as did the Jeff Kennett policies and closures from which health care has never recovered. During this time, what had by then become the School of Rural Health established four regional clinical schools and grew very quickly with an accompanying shift in focus to medical education. That left a gap in support for nursing and allied health – a gap Associate Professor Elaine Duffy and others sought to fill by establishing the Centre for Multi-Disciplinary Studies which focused on improving research, education and practice for nursing and allied health. It was within this environment that I worked on projects that aimed to effect concrete change at a local level – projects characterised by collaborative teams and relationships.

I began at the Centre for Rural Health as a research assistant working on the Small Rural Communities Project with Professor Roger Strasser, David Harvey and other researchers from the Monash Churchill campus. After two years, I took a break from the centre and became involved in Victoria’s development of nurse practitioners. It was as a member of the Victorian Department of Human Services nurse practitioner reference group that I first met Elaine Duffy.

Four years after leaving, I rejoined what was now the School of Rural Health to work with Heather Kelly and Peter O’Meara on the Urgent Care in Small Rural Communities Project. That project became Transforming Rural Urgent Care Systems. It resulted in the employment of a community ambulance officer in Mallacoota and an advanced practice nurse for the Mt Buller/Mt Stirling year-round health clinic.

My involvement with nursing practice continued on other projects. Phillippa Greene – a ‘bush nurse’ from Buchan – and I worked on the Quality Care in the Bush project and together we supported candidates seeking endorsement as nurse practitioners in Victoria. Following this project, our involvement in health professional education and training increased.

A Monash double degree in nursing and rural health was developed by a multidisciplinary team and included three MUDRIH units – rural communities, rural health policy and rural practice models – which were taught to nurses at Gippsland and Peninsula campuses and in Mildura. Around the same time Elaine Duffy and the head of nursing at Monash, Tony Barnett, negotiated with the Victorian Department of Human Services to co-deliver, via distance education, a unit in therapeutic medication management which was accepted for Victorian nurse practitioner endorsement. These course developments treated students as colleagues and used assessment methods more applicable to adult learning.

My involvement as program manager of another educational project led to my current interest in interprofessional collaboration. The SPECTRUM program (Support Program for Education and Clinical Training of Rural Undergraduates in Mildura) involved Mildura staff, including Dr John Russell, and 11 Mildura health and education agencies, and developed interprofessional collaboration educational material that is still used today.

MUDRIH’s current interprofessional collaboration initiatives commenced in 2009 with the Building Capacity through Interprofessional Education Project. This project developed a student mapping model, a pre-workshop student video and an interprofessional collaboration workshop template and materials. At the same time we were working on the Extending Chronic Disease Management through Interprofessional Education Project.

All these initiatives involved working with local health agencies, and one of the closest relationships developed with Latrobe Community Health Services. MUDRIH established the Placement, Education and Research Unit to assist Latrobe Community Health Services to increase and improve student placements, and to facilitate education and research for staff using a capacity building model underpinned by interprofessional collaboration. Since the unit was established, 250 of the 400 Latrobe Community Health Services staff have participated in interprofessional collaboration programs and 32 student supervisors have been trained. Student placements have grown from 35 in 2009 – before the unit was set up – to 75 in 2010, and 151 in 2011. A research council has been formed with 16 active projects involving 27 staff.

With these experiences MUDRIH has also been able to establish much broader networks. Initially funded by MUDRIH, the Victorian Health and Social Care Interprofessional Network operated across Victoria and was subsequently funded by the Department of Human Services and Department of Health for another two years. The network organised a visit from Helena Low and Dawn Forman from the Centre for the Advancement of Interprofessional Education in the United Kingdom, which, following a suggestion from Dawn, eventually led me to form the Australasian Community of Interprofessional Collaborative Practice. The community includes representatives from academia and health services across Australia and New Zealand. These are people who operate at the health services coalface, who are actively engaged in delivering interprofessional collaboration programs, and who willingly share information and resources.

With support from head of school, Geoff Solarsh, and from Janice Chesters and Marlene Drysdale, I completed my masters degree in 2006. This was based on Part 2 of the Victorian Rural Nurse Project, Advanced Nursing Practice: A Bush Nursing Perspective, which was one of our early rural nursing projects. In turn, I have focused on supporting my colleagues and building structures and processes in all areas. Of course, buildings have made a difference, with the purpose-built Monash facility at Traralgon providing a fertile and productive working environment for my colleagues and me.

The story of MUDRIH’s development is one of many people. Roger Strasser, Elaine Duffy and Geoff Solarsh were wonderful leaders and great supporters of MUDRIH in its various incarnations. The innovative Centre for Multi-Disciplinary Studies team included Claire Rickard, Heather Kelly, Vicki Dane based in Mildura, Janice Chesters, Marlene Drysdale, Phillippa Greene based in Bairnsdale, Matthew McGrail with administrative support from Michael Elswyk, Leanne Turnbull and Janelle McGrail. That team expanded into MUDRIH and now includes a variety of educators and researchers. The Indigenous Health Unit expanded and new mental health researchers joined the team.

Monash’s internal and external changes have required us to adapt and identify new roles. Throughout, MUDRIH has provided wonderful opportunities for me to develop and grow professionally, and has enabled the development of lifelong friendships and networks. It has been a privilege to work with dedicated staff at MUDRIH and Latrobe Community Health Services as we strive to bridge the university/theory and practice/service gap.

Meeting in Moe 2005: left to right – Marlene Drysale, Matthew McGrail, Mollie Burlie, Anske Robinson.


1 Wainer, J; Bryant, L; Nobelius, A. 2002. ‘Introducing gender perspectives into medical curricula’. Research Report. School of Rural Health, Monash University.

2 Wainer, J. 2003. ‘Gender and the medical curriculum: A rural case study’. In Teaching Gender, Teaching Women’s Health: Case Studies in Medical and Health Sciences Education, edited by Manderson, L. New York: Haworth Press.

3 63rd UN Department of Public Information Non-Government Organisations Conference in Melbourne in 2010 at a workshop titled Incorporating Gender into Health Care and its Effect on Global Health and Achievement of the MDGs.

4 Wainer, J; Bryant, L; Strasser, R. 2001. ‘Sustainable rural practice for female general practitioners’. Australian Journal of Rural Health 9 (Supplement 1, December):

Wainer, J; Carson, D; Strasser, R. 2000. ‘Women and rural medical practice’. South African Journal of Family Practice 22 (6): 19–23.

Wainer, J; 2002. ‘Women in the rural medical workforce’. Proceedings of Integration – Working Together for Rural Medicine: The Australian College of Rural and Remote Medicine Scientific Forum held jointly with the RWAV Victorian Rural General Practice Conference. April; Melbourne, Victoria: 24–26.

Wainer, J; Nobelius, A; Colville, D. 2002. ‘A report on the experience of an international program in a gender perspective in medicine. Research Report. School of Rural Health, Monash University.

Wainer, J; Ginnane, J. 2001. ‘It’s where we live’. Report on the Victorian Female Rural Practitioner Survey. Melbourne: Rural Workforce Agency of Victoria.

5 Wonca Working Party on Rural Practice. 2000. ‘Calgary commitment to women in rural family medical practice’. [Internet]. World Organisation of Family Doctors (Wonca). Accessed 28 May 2012. Available from:

6 Wonca Working Party on Rural Practice. 2002. ‘Policy for female physicians in rural practice’. [Internet]. World Organisation of Family Doctors (Wonca). Accessed 28 May 2012. Available from:

7 Wonca Working Party on Rural Practice. ‘Women in rural practice working group’. [Internet]. World Organisation of Family Doctors (Wonca). Accessed 28 May 2012. Available from:

Duffy, Elaine, O’Meara, Peter, Chesters, Janice, Wainer, Jo, and Burley, Mollie. 2012. ‘Changing emphasis: Monash University’, in From a Broom Cupboard: 20 Years of Rural Health at Monash University, edited by Clough, Robert. Melbourne: Monash University Publishing. Pp. 17–34.

From a broom cupboard: 20 years of rural health at Monash University

   by Robert Clough, editor