Rural Round-up: reflections on three years

Photo: the WWPRP meet in Dubrovnik

New Year Greetings and reflections on the last three years of the WONCA Working Party on Rural Practice

On behalf of the WONCA Working Party on Rural Practice (WWPRP), I wish you all a Happy and Prosperous New Year. We are coming to the end of our latest triennium and it’s a good time to reflect on what we have achieved and what we need to do in the next three years. The world remains a turbulent place and some of our rural colleagues are struggling to provide care against all the odds due to conflict, natural disasters and appalling poverty in some of the most inaccessible parts of the world. Some of us working in the highly sophisticated health systems in the developed world can often forget that many of the poorest rural peoples of the world have no access to basic medical care. 70% of the worlds 1.4 billion poorest people still live in rural areas.

This year sees the launch of the 17 United Nations Sustainable Development Goals. These replace the eight Millennium Development Goals, which heralded the start of this new Millennium. The debate on their effectiveness will continue for some time but I believe that they have had a significant impact in reducing poverty and improving access to healthcare worldwide. The new Goals are even more ambitious and I feel that we in Rural WONCA must work to highlight the plight of half the world’s population who live in the rural areas. The growing talk is about Universal Health Coverage and many countries have committed themselves to achieving this by 2032. It will be the rural and isolated areas that will pose the biggest challenges for governments and health planners when only 25% of the world health care workers provide care for 49% of the world’s rural people. Improving rural recruitment and retention will always remain one of our major goals.

We in the WWPRP committed ourselves to a number goals in Prague in 2013. These included:

1. Improving communication and making the WWPRP more visible. I am particularly grateful to Jo Scott Jones, Karen Flegg and Ewen McPhee for their help. We now have an active Google Discussion Group, a Rural WONCA Facebook Page, a Rural WONCA Twitter Account and a monthly rural article in WONCA News. These initiatives have extended our reach and made us more accessible. In addition a Rural Young Doctor & Student Facebook Page has been established by Veronika Rasic and Mayara Floss runs a wonderful innovative “Rural Café” on Google Hangouts.

2. Membership of the WWPRP

a. The successful WWPRP needed to engage with the next generation and identify the future leaders for the rural movement. This has been one of the most exciting developments. We now have direct representation from 4 of the 7 Young Doctor Movements and it is my aim to ensure that they will all soon be represented in the WWPRP. It is exciting to see some of these younger doctors & students already leading some of our initiatives.

b. We have also made a clear commitment to Gender Equity. More women are joining the WP and I am delighted to say that our Executive already demonstrates equal gender representation.

c. Finally Rural WONCA has traditionally reflected a significant bias towards the developed world. Its is often harder to recruit members from low and middle income countries because of travel and communication costs. The new communication strategy has helped engage new members and achieve a better degree of geographical equity. It is my belief that we should be replicating the success of the EURIPA (the European Regional Rural Group) by establishing regional rural groups in all WONCA’s regions. I am delighted to say that regional groups have already been established in South America and South Asia and again I aim to ensure that this will be achieved across all of WONCA.

3. The Rural Medical Education Guidebook was launched in Gramado, Brazil in 2014. This initiative was supported by The World Health Organisation who were impressed by the wide range of expertise and experience they found within Rural WONCA. Thanks to all those international authors who contributed over 70 chapters and special thanks to the Bruce Chater and his editorial team who worked so hard to make it happen.

4. Conferences: We held 2 very successful World Rural Health Conferences in Gramado, Brazil in 2014 and in Dubrovnik, Croatia in 2015. Like so many of our conferences before, they have already left a legacy, which continues to grow locally and across their regions. Special thanks to Leonardo Targa and his team from Brazil and to Tanja Pekez-Pavlisko and Ines Balint and their team in Croatia.

5. Working with other working groups, SIGs and NGOs: We have continued to work with global & regional groups and special interest groups within WONCA (eg Women, Environment, Point of Care Testing, Vasco de Gama etc) and organisations, NGOs and Professional Organisations (eg Towards Unity for Health, International Commision on Occupational Health, ACRRM etc.)

6. Rural Resource Website: Special thanks to Dave Schmitz from Idaho who has helped us establish a rural online site where grey literature and important rural documents can be stored and made easily available. So much rural literature just seems to disappear and now we have somewhere to store it.

7. Rural Generalism: There has been a growing need to ensure that rural doctors have the skills that specific contexts require. These skills can range from special rural primary care skills needed in practice such as emergency care, mental health, minor surgery etc to specific procedural skills such as interventionist obstetrics, anaesthetics, surgery etc. The Australian College of Rural and Remote Medicine (ACRRM) and The Canadian Society of Rural Physicians have developed the concept of “The Rural Generalist” and we in Rural WONCA are supportive of this important initiative.

I believe that we have achieved much over the last 3 years but we still have much to do. The WWPRP will be meeting in Rio de Janeiro in November 2016 for the WONCA World Coference.  We are working with the Brazilian Rural Group and the South American (CIMF) Rural Group to bring you a comprehensive rural programme. We will also be meeting before the conference to establish our work plan for 2016-19.

Some of our future aims will include:

1. A new document on the future structure of the WWPRP and roles and responsibilities of its members and officers

2. World Rural Health Conferences planned for Australia (Cairns 2017) and Uganda (2018)

3. Plans to ensure that all the WONCA Regions Yong Doctor Movements are represented on the WWPRP and the establishment of regional rural representative groups.

4. We will continue to extend our membership to include young doctors, more women and representation from low and middle income countries

5. Continue to develop programmes such as the Rural Heroes Project, The Rural Resource Page, The Rural Medical Education Guidebook and many more. In addition we will be publishing policies on “Rural Proofing” and the roles of Nurse Practitioners and Physicians Assistants in Rural Practice. We are also reviewing our past declarations, statements and publications.

Finally, I would like to thank YOU all for your help and support over the last 3 years. It has certainly been a privilege to chair this exciting organisation & network and I look forward to meeting you in Rio, Cairns, Kampala or just “On-line”

John Wynn-Jones
Chair WONCA Working Party on Rural Practice.
contact John: WPrural@wonca.net

PS. Please forgive me if I left out something or someone.