Tackling health at population level

JCU GP registrar Dr Jay Short has been part of North Queensland’s public health response to everything from COVID-19 to monkeypox, bat bites, melioidosis, meningococcal disease, diphtheria, Hendra virus and Japanese encephalitis in 2022.

In December, Dr Short becomes the first Australian College of Rural and Remote Medicine (ACRRM) registrar to complete Advanced Specialised Training in population health in Townsville.

Dr Short worked as a remote area nurse across Australia for 13 years before completing his medical degree at James Cook University in 2018. His deep knowledge of the region’s remote Aboriginal and Torres Strait Islander communities has proved invaluable for the Townsville Public Health Unit, which manages multiple disease outbreaks concurrently across a vast area.

Dr Short’s JCU supervisor, public health physician Dr Nishila Moodley, draws an analogy between public health specialists and the sci-fi secret agents of the Men in Black films. While the COVID-19 pandemic has elevated the specialty’s profile, much of their work still goes under the radar.

“If we do our job correctly, no one knows we're there. That's why people don't know who we are. I always tell them, we're like the Men in Black,” says Dr Moodley.

“In Townsville, we've never really had an alpha or beta COVID-19 outbreak because we had responded clinically to those individual cases so rapidly that infection didn't get a chance to establish itself here.”

Protecting rural and remote North Queensland

Dr Moodley taught into the undergraduate medicine program at JCU before joining the region’s public health response in November 2020, during the first year of the COVID-19 pandemic. As well as infectious disease control and prevention, her team’s diverse responsibilities cover areas such as water and sanitation, disease exposures in the workplace, sexual health and immunisation.

“We work across the Townsville, Mackay and North West hospital and health services and the discrete communities of Doomadgee, Mornington Island and Palm Island. Jay has been integral in in managing disease outbreaks in all of those areas,” Dr Moodley says.

ACRRM identifies AST in population health as a priority for rural and remote general practitioners because of the likelihood they will be first responders in infectious disease outbreaks, and its importance in addressing inequity of health outcomes in rural and remote communities.

“Often, resources get concentrated in more urban, highly inhabited areas and so when there's an outbreak, whether it's COVID-19 or influenza, we have the infrastructure in a central area to manage that,” Dr Moodley says.

“As you go more and more into the rural areas, the role of the rural physician becomes more important, whereas in the central area, you can call on public health physicians and we do the contact tracing. It's not just about treating a person who has the disease, it's about treating the people around it, and that's what public health is about. It's about ensuring the impact of a disease does not spread very broadly.”

“Because we are in a tropical area, we get more tropical diseases. With things like climate change and with constant migration of people with disease, parameters have changed, and we've had to respond to that.”

‘This job is really about communicating’

Communication skills are key to what Dr Short has been able to offer for public health in rural and remote Aboriginal and Torres Strait Islander communities, where working in partnership with Indigenous health services and leaders has been the key to culturally safe care and disease prevention. On Palm Island, messaging on local radio and a partnership with the Palm Island Community Company (PICC) have been highly effective.

“We've seen waning COVID-19 vaccination rates over the three doses, whereas on Palm, we've had really good uptake and community engagement,” he says. “Therefore the social messaging doesn't come from the government, but rather internally, from the Aboriginal Medical Service and from the council, and so you get better buy-in, and better outcomes overall. This job is really about communicating and being able to communicate at different levels.”

Dr Moodley says establishing networks is central to public health. “It's a relationship that's constantly building, and you're troubleshooting for much longer in Public Health than it would take to do the acute management of a case,” she says.

“In dealing with diphtheria cases, for example, yes, you have to give antibiotics, yes, you have to give medication, and you've got to swab people, but it's so much more than that. It's about building a rapport with the community and presenting a service to them so that you're not taking over what they're trying to do but you're supporting them, and they feel supported to assist you. “

“That, for me was the very complex part of the whole puzzle wherever we have worked, because it's people who are being introduced to new diseases, and intricacies of disease. You have to make it culturally appropriate, you have to make it safe, and you have to be able to communicate the issues that we're having. That's been a large component of what Jay's done.”

Coordinating response on the ground

Dr Short’s rural and remote placement has helped overcome some of the logistical issues facing the unit. “Jay’s willingness to go out has added a very clinical dimension to public health, which has been very advantageous and has been very successful with many of our initiatives during the year,” Dr Moodley says.

“Another important paradigm with public health is that it's preventive medicine. Jay has been involved with a lot of communications we've had with GPs. Prior to the onset of the flu season, we did a talk on the impact of flu and COVID-19, recorded a lecture and prepared materials for GPs. Once we started seeing monkeypox and meningococcal cases, we again prepared a disease update on the important conditions that were circulating and what we had been experiencing. “

“Public health is about keeping the lines of communication open. Jay has been involved in a lot of that with the communities because it's not just about us telling them what needs to get done. It's about us facilitating it getting done.”

“You have to be able to give that same message at all those levels consistently, which takes quite a bit of skill because medical language is filled with jargon, and often it's lay people that you have to speak with, and you have to get them to understand.”

Dr Short has embraced the chance to use his knowledge of the discrete communities in the northwest and the complexities of life in First Nations, rural and remote communities. “That’s been a really big bonus for me, because I think it's made it very easy for me to be able to fit in here and be able to work out what needs to happen,” he says. “The knowledge of what's going on in the ground can really make a process quicker.”

Research opportunities in public health

The GP registrar rural placement role at the Townsville Public Health Unit has also opened up research opportunities.  “A lot of the guidelines that are created at national and state level are constantly being revised, to meet changing trends and epidemiology,” Dr Moodley says. “As a registrar, Jay has been offered the opportunity to comment into these and to advise him to update these documents. He's involved in research projects with us as well.”

One project is examining the First Nations COVID response. “We’re looking at the waves of COVID-19, the management within indigenous communities, considering vaccination rates and the epi curves. This is being done across Cape and Torres, Cairns, Palm Island, Woorabinda and a couple of other Indigenous communities down south,” Dr Short says.

NQRTH connects medical students, intern and junior doctors with a network of opportunities and resources designed to create a supportive and clear path to specialist (including general practice) training, and beyond, in our regions. Our network works together to strengthen medical specialist training with the view to build a health workforce prepared to meet the health needs of our regional and rural communities in Cairns, Central West, Mackay, North West, Torres and Cape, and Townsville. NQRTH is facilitated by James Cook University, who partner with hospital and health services and training providers to create a connected career pathway beginning at the medical undergraduate level right through to fellowship.