The 2023 annual edition of Nordocs Magazine was the first since Dr Andrew Binns’ retirement 12 months ago, although  retirement may not be the correct word, as Andrew has been instrumental once again in starting, or perhaps more accurately restarting, a medical magazine for the North Coast. 

He has also been active in medical matters, not as a primary physician, but through his work with Rekindling the Spirit and the evolution of the Nimbin Collaborative. The aim of the Collaborative is to address some of the social determinants of health in the Aboriginal and Nimbin communities

This edition of “NorMag” is a bumper edition and has been made possible by generous sponsorship from Healthy North Coast (HNC) and the North Coast Primary Health Network (NCPHN). 

As a result this edition goes not only to previous readers on the Far North and Gold Coasts but also to the Mid North Coast and the Hastings/Macleay region. 

The magazine is distributed through Sonic Healthcare’s subsidiaries. Sullivan and Nicolaides Pathology is a long term supporter of the magazine and has distributed it for some years. For this edition we welcome Douglass, Hanly, Moir Pathology who will be assisting in getting the magazine out in the lower half of the NCPHN’s footprint, down to Port Macquarie and Laurieton. 

Australian health policy is a heavily laden ship. It takes a lot to get it moving and to nudge it in the desired direction. It takes new governments somewhere between one and three years for new policy to be implemented. The ten year plan for primary health was released 18 months ago and had bipartisan support. From 1 October  2023 we are seeing the first steps of the government’s MyMedicare primary health care policy. 

Monika Wheeler, HNC CEO, outlines the broad aims of the policy and Adrian Gilliland, HNC Chair, delves into the benefits of the new program for the care of the elderly and those with a high burden of disease.

Our cover and page 9 feature images by local photographer, Jacklyn  Wagner, of the continuing human tragedy following the disaster of the February 2022 North Coast flooding. Many local residents and local MP, Janelle Saffin, have been disappointed by the curtailment of the “buy back” program in the NSW 2023 budget and the further trauma this is causing these struggling members of our community.

On page 30 Dr Eric Brymer from Southern Cross University (which is  another returning sponsor) and his colleagues report on their ongoing research into the trauma caused by environmental disasters such as bushfires and floods. 

For some there is light at the end of the tunnel. Dr Nina Robertson on page 11updates the progress that has been made since the floods destroyed the Keen Street Clinic. Nina loves her job, her patients and “the undifferentiation and complexity of general practice” and “the autonomy of running her own business.“ Months of blood, sweat and tears… and dollars have been expended, but they have survived and hopefully can now prosper.

There have also been developments on the Far North Coast for the health system infrastructure. On page 26 we note that The Tweed Hospital is nearing completion and are pleased to report that another long term supporter of the magazine, St Vincent’s Private Hospital, is planning a green fields development of a new hospital near the existing Lismore Base Hospital (page 6). 

On page 31 we welcome Sarah Mollard, to the magazine. Sarah is a GP and climate campaigner based in Port Macquarie. She gives practical tips on how we can reduce our energy consumption at the “micro” level. Similar success has been reported at the meso level by Ramsay Health  which has  three major hospitals in our area. A recent NEJM article noted the 20 percent  reduction in costs at Massachusetts General through energy conscious process redesign. 

Coffs Harbour GP, Dr Nicola Holmes has a long term interest in mental health management in general practice. Her tips for GPs (page 32) emphasise the importance of “being with the patient” rather than putting them in a diagnostic box and fixing them with medication. 

It’s hard to find a drug that improves the mess you’ve made of your life. Taking some away is usually a more successful strategy. This was the subject of Chairman Nathan Kesteven’s talk on the “Open Dialogue” movement at the Nordocs Unconference in May this year. 

A similar approach has been the modus operandi for long serving North Coast psychiatrist, Harry Freeman. On page 10 we pay tribute to Harry and his years of service to the local community. To learn more about Harry and his approach to psychiatry we highly recommend his ABC RN  Conversation with Sarah Kanoswki, “Dr Freakman, hippie psychiatrist” recorded in August this year.

Nordocs compromises all members of the North Coast medical community. As North Coast Hospitals interns come to the end of their first year we have an update on their experiences from their representatives in Port Macquarie, Coffs and Lismore (page 16). 

As Rik Lane, Director of Prevocational Education and Training, Lismore Base Hospital notes, one’s first year as a doctor is a stressful time (page 10) but our JMOs appear to have enjoyed working here and have been grateful for the support they received from the local medical community. We hope that many of them, like us in the past, will take up the North Coast lifestyle and contribute to the care of our communities. 

Australia has some of the highest rates of rheumatic fever and rheumatic heart disease (RHD) in the world. It is an international disgrace that this is almost solely confined to First Nations peoples. The cause is a high incidence of Group A streptococcal (GAS) disease resulting from poor living conditions. 

Dr Ben Hunt, writing in the MJA’s Insight+ magazine, notes that the issue can be addressed at four levels - prevention through better housing and hygiene, early recognition and treatment of GAS, secondary prevention of recurrences that lead to ongoing valvular damage and finally heart valve surgery. He writes that these approaches to disease prevention and management are siloed and that a Voice to Parliament has the potential to address the underlying causes and in turn decrease the incidence and prevalence of RHD. 

Dr Marion Tait, GP at Bulgarr Ngaru, Casino, recognised the rising incidence of this preventable and tragic disease several years ago. On page 12 she describes what she, and we, can do in the second and third siloes to help reduce the morbidity and mortality of this disease. 

Dr Tait and her team are to be congratulated on their individual efforts to address the prevention of RHD on the North Coast. Nordocs believes that supporting activities like this is a crucial component of a highly functioning health system. Much can be achieved by tapping into the knowledge and expertise of local general practitioners but they need government support.