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Anthill and other injuries: A case for mobile allied health teams to remote Australia
O. Allen
The Australian Journal of Rural Health © Volume 4 Number 1, February 1996
dust. J. Rural Health (1996) 4, 33-42
Original Article
ANTHILLANDOTHERINJURIES:ACASE FORMOBILEALLIEDHEALTHTEAMSTO
: REMOTEAUSTRALIA
Physiotherapy Department, Atherton Hospital, Peninsula and Torres Strait Regional Health Authority, Atherton, Queensland, Australia
ABSTRACT: Remote rural districts of Australia can continue to expect a loss of public services
due to the low population density and migration loss. However allied health services such as
physiotherapy, are cost-effective services that are in demand in remote Australia. This paper was
derived from a report to the Rural Health Policy Unit of Queensland Health that granted funds for
a mobile allied health team to visit the remote western shires of the Peninsula and Torres Strait health region. By presenting an outline of an unusual group of parochial occupational injuries it
can be shown that there is indeed both a considerable demand for allied health services and these
services can be provided to remote communities by a mobile remote outreach service for a
reasonable cost.
KEY WORDS: allied health, occupational injuries, physiotherapy, primary health care, rural health.
INTRODUCTION
Remote rural districts of Australia can continue to expect a loss of public services to rural and
remote localities due to the low population den-
sity and the migration loss.1 The Croydon and Etheridge Shires in north Western Queensland are two such localities. Informal consultations
with these communities by officers of the Penin- sula and Torres Strait Regional Health Authority
in 1991 showed that allied health services which
include physiotherapy, occupational therapy and social work were in demand.
The planning of services in remote areas of
Correspondence: 0. Allen, c\o PO Box 183, Ather- ton, Qld 4883, Australia.
Acceptedforpublication May 1995.
decreasing population may ordinarily prevent
new health services being established. However,
in January 1994, the Rural Health Policy Unit of
Queensland granted an allied health team from
the tableland sector of the Peninsula and Torres
Strait Regional Health Authority, funds to provide
a monthly/bimonthly mobile service to the shires
of Etheridge and Croydon which form the remote
western border of the authority. This paper will
attempt to highlight initial insights into the need,
establishment, cost and effectiveness of allied
health services (especially by an analysis of the
physiotherapy component of the Etheridge-Croy-
don -4llied Health Outreach Services). It is hoped
that this report of a successful remote mobile
allied health team will help others in the planning
of services in remote Australia.
34 AUSTRALIAN JOURNAL OF RURAL HEALTH
ESTABLISHMENT OF REMOTE ALLIED HEALTH SERVICES
The process of designing a successful grant sub-
mission exposes the skills needed by rural health
professionals and reiterates many of the problems
that are experienced by rural allied health
services.
Essential to a successful service design and
proposal were: (i) the continuity of staff and their
rural experience; (ii) the professional develop-
ment of staff in terms of management skills; and
(iii) the ability to attract employees, especially as
casual backfill. The first two attributes provided
the skills and knowledge that were necessary for
professionals designing the outreach programme
and writing a concise proposal within a short
time-frame. The third attribute was a necessary
strategic condition for establishing the service. Evidence suggests that health management in
Queensland, outside metropolitan Brisbane, has
difficulty understanding the role of allied health
services and are poor advocates for these ser-
vices.2 Therefore allied health personnel are largely responsible for the development of allied
health se Fs in rural Queensland, even though few allied health professionals are employed in
management positions. In the Atherton sector, the
key to a successful grant proposal was in the local allied health professionals maintaining the goal of
achieving services to the remote communities,
until the opportunity of grant funding for remote
allied health services eventually arose. Rural
allied health professionals, whose average stay in
rural positions is between 13-18 months and
23-24% of whom are new graduates,3 often have a lack of local knowledge and service delivery
planning experience, and therefore they may easily miss opportunities for establishing new
services.
With regard to the provision of the service,
fortunately there were underemployed profession-
als in the district who were able to fill the casual
backfill vacancies to allow the service to com-
mence. At the time of writing this paper, this
strategy has become problematic due to the
casual physiotherapist attaining full-time employ-
ment in another unit. This again points to the
need for different structures for the supply of
allied health services, as noted by Hodgson in her
1993 survey of allied health workers in Queens-
land.2
The major advantage for the mobile team was
the existing heath infrastructure in these remote
communities, namely clinics in Croydon, For-
sayth and Georgetown, and contact persons in Mt.
Surprise and Einasleigh. The latter towns used
their local dance hall to double as a Royal Flying
Doctor Service clinic and it is available as a base
for our outreach team.
Teamwork proved to be another advantage in
service delivery. After the outreach team had
made a few trips, it was recognised how important
the team itself was in supporting its members. Consultation throughout and after the trips has
been vital to problem solving in the remote
communities.
PRIMARY HEALTH CARE
Primary health care considerations were para-
mount to the development of the Croydon-
Etheridge Allied Health Outreach Project. The
community consultations of 1991 for health plan- ning in the Peninsula and Torres Strait region,
which resulted in a management awareness of the
community’s desire for allied health services, ful- filled the basic primary health care condition of
community participation.3 The current Queens- land health policy document on primary health
care (1993) encourages this approach while indi-
cating that one of the challenges is the establish- ment of functional links with all health care
providers including allied health professionals.“ The same document describes the national initia-
tives aimed at strengthening the primary health
care sector. These include: the Home and Com-
munity Care Program (HAAC); National Women’s
Health Program; National Aboriginal Health
Strategy; and Community Organisations Support
Program, with strong emphasis on equity of
access and innovations that encourage collabora-
ANTHILLINJURIES:O.ALLEN 35
tion of general practitioners, allied health profes-
sionals and other workers in health promotions
and local health planning. While the HAAC pro-
gram provides the services of non-clinical person-
nel who have proved valuable as links between
aged clients in their home, remote clinics and
mobile allied health services, other innovations of the National Health Strategy have so far not
addressed allied health services in rural North Queensland.
The key components in the appropriate deliv-
ery of health care that were considered in the
design of the mobile allied health service
included: accessibility, relevance, functional inte-
gration, cost effectiveness, equitable redistribu-
tion of resources, improvement of planning and
management. The project itself was designed after
evaluating from three sources: (i) an estimate of
phone calls from remote clinics asking for advice
INSET
for clients; (ii) an estimate of the number of clients
who had visited -4therton and Mareeba hospital
allied health departments from the remote dis-
tricts; and (iii) an acknowledgement that the dis-
trict of Croydon and Etheridge Shires had a sparse
population (1658 people at 1991 census)5 living in
five towns and surrounding countryside in an area
about 70 000 km” or approximately a third larger
than Tasmania (Fig. 1). The problem was how to cost-effectively fulfil
the obligation of equity of service to the remote
shires. The project details were extracted through
intense consultation and it was decided that the
cost-effectiveness would come from the allied
health professionals travelling in a team by road.
The costs of travel in terms of funding and per-
sonnel stress and the expected low numbers of
clients meant that the outreach visits would be
the minimum conceivable for a viable service.
Cape York Peninsula
Gulf of Carpentaria
Kabanyama hl Cooktown
i
FIGURE 1: The approximate catchmeti area of the Etheridge-Croydon Allied Health Remote Outreach Team.
Croydon is approximately 6 h drivefrom Atherton.
36 AUSTRALIAN JOURNALOFRURALHEALTH
(Viability was considered to be a favourable out-
come in terms of clinical assessment and client
feedback). It was evident that the differences in
working behaviour of physiotherapist, occupa-
tional therapist and social worker needed to be
considered when estimating the time needs for
the team. For example, the social worker and
occupational therapist may need to make home
visits to homesteads that may take up to one hour
in driving time from the remote clinic. This led to
the inclusion of a minor role for health promotion
and inservice education for remote nursing and
HAAC staff by the allied health professionals to
derive optimal productivity. The utilisation of ser-
vices by clients has been better than expected,
limiting forays into these extra programs.
In particular the team was aware that the
institutional-based service procedures would
need modification without compromising success-
ful outcomes for clients. An extra ‘case organisa-
tion’ day was included in the project to ensure
success ul outcomes through follow-up work after
1 the remo e trip. Another benefit of having a team
of experienced professionals was the knowledge
base to help the clients derive appropriate solu- tions. Examples would be: the difficulties of the
placement of elderly in a nursing home where the
nearest is 300 km away; dealing with child abuse or domestic violence; or managing psychiatric clients. The examples have provided challenges
that required a high standard of problem solving ability enhanced by an intimate knowledge of
local structures of support across public depart-
ments. However, social work services considered that they were not having the desired effect due to
the short time the service was able to spend in
each town. The team was also aware that one town, Croy-
don, had a 50% Aboriginal population. While it
was recognised that many of the primary health-
care components still needed to be addressed in
regard to this special group, no particular account of processes was incorporated into the initial
design. This failure is indicative of the paucity of
management of allied health services, which
needs further development, especially if larger
unserviced areas such as Cape York Peninsula
communities are to be provided with adequate
service.
PHYSIOTHERAPY SERVICES
As an example of the need of allied health ser-
vices in remote Australia, the following discus-
sion will focus on the Croydon-Etheridge shires
physiotherapy services.
The physiotherapy service to the shires of
Etheridge and Croydon began in February 1994.
On the initial outreach trip, public meetings were
attended to present the services to the communi-
ties. This included a separate meeting with the
Waratah Aboriginal Co-operative in Croydon.
Further client contact for physiotherapy has been
made through the clinics by appointment or
arrangement for home visit. Fifty-nine clients
sought physiotherapy care in the first 4 months of
the service. The expectation that a number of
clients would seek services for the usual but long-
standing musculoskeletal pain syndromes were
confirmed with the attendance of 30 such clients
out of 59 for physiotherapy (Fig. 2). The other 29 clients attended with acute mus-
culoskeletal pain/injuries. There were no other
types of clients in this first 4 months, although later clients included one with multiple sclerosis,
one with Alzheimer’s disease and other age-
8% Anthill injunes
51% Longstanding MSP and
dysfunction
FIGURE 2: Distribution ofphysiotherapy client types
seen in the3rst 4 months of the Croydon-Etheridge
Outreach Service in 1994. Note: MSP on the pie graph
refers to musculoskeletal pain.
ANTHILL INJURIES: 0. ALLEN 37
related problems, and two child bearing women.
One session on injuries with seventh grade stu-
dents of the Georgetown school was facilitated
during this time. Informal inservice discussions
were also held with nursing staff at the clinics at
each visit.
Among the clients seen early in the service
were two cases that underscore the need for a
diversity of health professional services in remote
communities. The first of these was a 60 year old
woman with a 4 year history of rotator cuff pain
and dysfunction following an injury. The woman
had seen a physiotherapist on one occasion shortly after the initial injury and, due to the
tyranny of distance, had not sought follow-up. By
the time of this second review, the pain and dys-
function had increased to the extent that the
woman had already been referred to an
orthopaedic surgeon and had been subsequently
booked for an arthroscopy and possible rotator
cuff repair or other decompression procedure.
While it is acknowledged that some injuries will
create a permanent structural damage and/or
change to subacromial and rotator cuff tissue which conservative therapeutic approaches may not be able to reverse, between N-86% of full thickness rotator cuff tears have been reported as
progressing well with conservative treatment if started within the first year of injury.6 As exer-
cises are a mainstay of conservative approaches,
regular, if not frequent, mobile services can pro- vide valuable programs for clients with muscu-
loskeletal disorders, with the expectation that
there would be a reduction of pain and dysfunc- tion. This would also result in a reduction of costs through prevention of the need for orthopaedic
surgery. The second of these clients was an 83 year old
woman, living independently, who was having dif-
ficulty walking although she was using a walking
frame. On assessment it was revealed that the
woman had a total knee replacement 10 years ear-
lier and it was this leg that she was having diffi-
culty using. It was quickly ascertained that the
arthroplasty was grossly unstable in the varus position. It was evident that the instability had
been developing for a considerable time and,
although the woman had been reviewed by a gen-
eral practitioner. management strategies had not
been instigated. After physiotherapy assessment,
the client was reviewed by an orthopaedic sur-
geon who confirmed the diagnosis. After consid-
eration by surgeon, orthotist, and reviews by physiotherapist and occupational therapist, the
use of a knee brace appropriate to climate, knee
condition and manual dexterity of the client, and
wheelchair mobility (as needed) became the
eventual strate,g. The physiotherapy and rehabilitative models
in the Australian health environment, have their
forte in human movement and formulating strate-
gies where dysfunction exists. It is strongly sup-
portive of orthopaedics and neurology and, where
this model is not applied within the health ser-
vices delivery, as these examples show, the needs
of the community are not being fulfilled, resulting
in ongoing unnecessary hardship for those in
need.
ANTHILL AND OTHER,MUSTERING INJURIES
This view is further supported by occupational
injuries seen in the Croydon and Etheridge
shires. Through the physiotherapy outreach ser-
vice it is estimated that approximately 2% of the population may be seeking physiotherapy ser- vices for an occupational injury each year. This is
about half of the possible numbers of injured
workers as compared with occupational injuries in Queensland. These account for approximately
4.7% of the population (Table 1). Of these, a set of parochial occupational
injuries caught the attention soon after the com-
mencement of physiotherapy services. Anthill
injuries are peculiar to the beef cattle industry in
a geography with vast quantities of anthills and
where mustering is performed on motorbike. The
injury usually occurs when the rider, watching the
movement of the cattle, turns too tightly to round an anthill, clipping it with a foot or knee. The injury depends on: the speed of travel; the angle
38 AUSTRALIAN JOURNAL OF RURAL HEALTH
TABLE 1: Workers Compensation Board of
Queensland Statistics.fir 1993-94
Queensland population 3.178 million
Total workforce 1.5 million
Workforce covered by
Queensland Workers
Compensation Board 920 600
Total Queensland Workers
Compensation Board Claims
1993-94 92 741(10.07%)
Total mustering injuries claimed
Queensland Workers
Compensation Board 53
Soft tissue mustering injuries
claimed QWCB (i.e. injuries
not fractures or lacerations) 19
If 10% total workforce are injured yearly, there are
150 000 injured workers or 4.7% of the population.
and point of impact; and the density of the anthill
(hollow, active or built around a tree stump).
The five injuries from a collision with an
anthill while mustering, seen between March and
June 1994, varied from two males with contused
foot and haemarthrosis of the first metatarso-
phalangeal joint; one male with shoulder, neck
and back strain; one male with a discogenic
lesion in the lumbar spine; and a female with a
contusion of the left lower leg. All injuries recov-
ered following advice for home-care (e.g. rest, ice, compression and elevation (RICE), exercises, and
a minimum of other therapeutic interventions
such as ultrasound and manual therapy). These injuries account for 30% of occupational injuries
and 17% of all acute injuries seen during the
same period in those shires.
A similar type of injury happens during mus-
tering on horseback. This places the rider’s feet
above the height of anthills in the Croydon-For-
sayth district; however, the agile horse can
quickly turn about a tree without leaving room for
the rider’s knee. In the 5 month time period from March to July 1994, one stockhand (5% occupa-
tional injuries) presented following this type of ac*cident that left him with a dislocated patella
and a grade 2 tear of the medial collateral liga- ment of the knee.
It is difficult to make a comparison of these
injuries with similar types in other industries or
even in the greater pastoral industry because of
the lack of epidemiological statistics on injuries
in Australia. This problem has been found by
other workers who have developed data collection systems7 and, while the Queensland Workers Compensation Board collates statistics on injury
sites and industry, the exact cause of injury is
unavailable. Data from the Workers Compensa-
tion Board of Queensland shows for 1993/94 only
19 claims for all soft tissue injuries involving
mustering in Queensland. Considering the find-
ings from the Croydon-Etheridge Shires, it is
probable that many mustering injuries are not
notified through the Workers Compensation Board
mechanism. There seems little value to be
derived from the current databases for under-
standing the rate of injury and thereby helping
reduce that rate. Until databases can relate the
nature and site of injury, and incident, they will not be valuable in reducing many types of injuries
such as mustering injuries because, as anthill
injuries show, v ‘ous different types and sites of /”
injury can be the result of very similar types of
accidents. The data taken from physiotherapy
clients (above) indicate that to reduce injuries in
mustering in the Croydon-Etheridge Shires, the
whole issue of using motor bikes in areas of high density anthills needs to be discussed. In remote
communities, a clinic-centred and Royal Flying
Doctor Service database might be a more appro- priate collation point for a state wide database of rural injuries. Perhaps the Australian Diagnostic
Related Groups (AN-DRG) system operating as the standard categorisation of patients may be the
most advantageous database to extend use of in
the private sector, including medical and physio-
therapy clinics, in order to develop adequate data
for epidemiological studies. The physiotherapist
is otherwise well situated with professional knowledge to facilitate the primary health care
process for developing preventative measures for mustering or other industrial injuries.
ANTHILL INJURIES: 0. ALLEN
Apart from anthill injuries, a worrying trend of
injuries that was seen during the remote outreach
trips were long standing moderately severe neck
complaints that dated back to a fall from a horse.
The cases seen so far have all been female. Their
ages at the time of fall were 17, 20 and 54 years
respectively. Their symptoms included head- aches, dizziness, muscle tension and stiffness, all
of which had been ongoing for 5-15 years.
Responses to physiotherapy were favourable in
the cases of the younger women although less
successful for the older woman. An equal number
of women have also been seen for ongoing lumbar
spine pain from horse falls dating back to their
teens. The greater concern that these injuries
raise are the potential danger of horse riding for
recreation or occupation. While the Princess Alexander Spinal Unit of Brisbane only registered
seven out of 285 spinal injuries (2.4%) over a 4 year period as attributed to horse riding,8 there
may be a far greater proportion of severe soft tis-
sue injuries from horse riding that cause loss of
quality of life and productivity. As we have seen
through the mobile service, even many years after injury? physiotherapy services are beneficial in
assisting the injured person in recovering much
of that quality of life. However providing regular
services to remote communities should ensure
that the injured person does not suffer pain and
dysfunction beyond a reasonable time frame for the healing of soft tissue and rehabilitation of
movement to occur. Surprisingly, we have not encountered any
severely head/spinal cord injured stockhands.
This may be due to the need for anyone severely
challenged to migrate to a coastal town where ser- vices are readily accessible. Alternatively, in spite of the apparent danger of mustering, severe and
fatal injuries may be infrequent. The incidence of head injuries in Queensland is 2-3 per 1000 of population, 10% of these are severe.11 By compar-
ison, Atherton hospital, with a catchment popula-
tion of approximately 18 000 people and a large horse-sports following had admitted only four
moderate cases of head injury from horse falls in
the year 1993-94 which is only 2 per 10 000.
39
Interestingly the other mustering related
injuries seen in the Etheridge-Croydon Shires in
1994, in one male and one female, were caused
by a direct blow from a beast while they were
yarding cattle on foot. Princess Alexander Hospi-
tal also admitted 2 spinal cord injured patients
who had succumbed to cattle charges over a recent 4 year period.9 In light of these cases there
may be a serious risk in this aspect of mustering, in addition to other mustering related injuries.
Other occupational injuries seen in the Croy- don-Etheridge Shires mainly concern workers for
telecommunications, transport and retailers. There
are some parochial aspects even to these injuries,
such as the effect of long distance driving over
roads in poor condition. Apart from occupational injuries and other
musculoskeletal pain syndromes, clients needing
physiotherapy services include those who come
into the aged care category, childbearing women and childhood orthopaedic and developmental
problems. The services required in remote west-
em north Queensland are therefore similar to
those of the rural communities that have easy
access to Atherton hospital services, except at a
lower density. Delivery of antenatal education, for
example, has been provided on a one to one basis
and in a condensed fashion, while other areas of
potential need such as cardiac rehabilitation has
not been investigated. It is conceivable that there are also other versions of physiotherapy needs in the Aboriginal community but these have not
been explored either in the rural townships of the
Xtherton Tablelands or the remote districts.
Working towards the goals defined in the 1994 Queensland Aboriginal and Torres Strait Health
Policy should foster improvements in this area.10
COST COMPARISON REMOTE OUTREACH VERSUS HOSPITAL, BASED OUTPA4TIENT SERVICES
Cost comparisons of services are virtually impos- sible to ascertain at this time in Queensland,
especially in physiotherapy- and other allied
health professions. The breakdown of all costs
40 AUSTRALIAN JOURNAL OF RURAL HEALTH
even in a small hospital such as Atherton would
require a special study. However, the expenditure
data from Atherton hospital suggest that for every
occasion of service unit (one unit = 15 min direct
client contact) there is a cost of $7-10 in terms of
salaries and materials to provide and manage the
service, while this cost rises to about $36 for the
outreach service. (The data from which these fig-
ures were derived were obviously deficient for
both services because it didn’t include many
overhead items e.g. energy, administration.)
Physiotherapy services at Atherton hospital
are also estimated to be considerably underpro-
vided. However the figures give an idea of the dif-
ferential that can be expected with the provision
of mobile remote outreach services. Undoubtedly
the bulk of the extra cost is due to travel
expenses, although the pattern of service delivery
that is directed by the working pattern of the team
as a whole causes time management ineffrcien-
ties for the specific professionals. This happens
because the professionals will have a different
workload on each particular trip that may delay
arrival times at a clinic. For example, a home
visit half way between Croydon and Georgetown
is easiest made en route; however, this means that
the professionals not involved in the visit will be
delayed. The alternative may mean an extra 2
hours of travel for the professional wanting to make the home visit, which is not more efficient,
but also may prevent that professional time to see other clients.
The differences in therapeutic strategies
offered the remote client compared to the rural or urban client provide other variable for cost com-
parisons. These include differences in length of
service time per attendance and differences in
number of attendances per diagnostic category. Cost analysis would also need to take into
account the advantage to the allied health ser-
vices at the Atherton hospital that serves as the
base for the mobile team. These- advantages
include having a vehicle that can be used for
home visits on the Atherton tableland when not
used on remote services. This has helped reduce
costs of reimbursements for the use of private
vehicles. A detailed study of costs may uncover
many benefits which can be realised for the
urban/rural health base ai well as the remote
community. For example, another benefit arises
from the capacity for employment of extra physio-
therapy staff due to the need for backfilling posi-
tions at the service base. Increases in the number of staff, especially in rural hospitals which are
often staffed with a sole therapist, may provide
benefits in quality assurance, staff morale, profes-
sional education, as well as continuity services,
which are among the many challenges faced by
health professionals in rural Australia.11
With a reasonable approach and a moderate
level of funding, physiotherapy, occupational
therapy and social work services can be provided
to remote low populated districts of enormous
size, in this case in the vicinity of $40 000 annu- ally and several thousand dollars for establish-
ment costs, including assessment and therapeutic
equipment, to deliver services to an area larger
than Tasmania. Depending on needs, additions to
the team could include speech pathology and
podiatry. Up to four professionals in a vehicle,
with equipment, seems to provide comfortable
efficiencies.
CONCLUSION
The small towns that are dotted throughout the Australian countryside, providing the basic retail
and transport services for their district, create a
need for the broad spectrum of health services
including allied health services, as shown by the
remote Shires of Croydon-Etheridge. Although this paper has focused on physiotherapy services,
a similar story would unfold with occupational
therapy and social work services. Children and families are in considerable need of services, per-
haps more so because of their isolation from the
broader community and education supports
expected in more populated districts. The special
issues that families confront, either a child with
severe learning and behavioural disability,
domestic violence or substance abuse are
extremely delicate in these small remote commu-
ANTHILL INJURIES: 0. ALLEN 41
nities. Added to this, a proportion of clients will
need to drive over 1 hour to reach the nearest
remote clinic or vice versa for the health profes-
sional to visit clients at homes on cattle stations/
mining leases; deriving the best outcomes from
health services is difficult even with remote ser-
vices in situ.
Small towns like Croydon, Georgetown, For-
sayth, Einasleigh and Mt Surprise are also very
vulnerable to the socioeconomic changes of Aus-
tralia. Coinciding with our first outreach visit, the
only bank in this district closed its doors, leaving
a round trip to either Charters Towers or Atherton
of over 1000 km for people to actually visit a
bank. By the end of 1994 the people of Einasleigh
were forcefully protesting the closure of the rail-
way through the town. All the social, psychologi-
cal, environmental and economic difficulties that
remote communities experience exacts a steady
evaporation of the population. As the population / declines, health service per head of population
may become very expensive to maintain com-
pared with major centres. However, the mobile
allied health services to Croydon-Etheridge
Shires show that with a moderate budget, a net-
work infrastructure connecting clients, remote
clinics, district hospitals and their allied health
departments, general practitioners and specialist
services, and a regular albeit infrequent outreach
service, much of the client needs can be fulfilled.
In the worst case scenarios for remote communi-
ties, allied health services should be seen as min-
imal palliative support.
Economic analysis is sadly- lacking across the
spectrum of physiotherapy and allied health ser-
vices, and further analyses are required for ser-
vices managers to develop strategies that tackle
the goals for equity in health services in rural
Australia. Hand in hand with economic analysis,
an analysis of the management of allied health
services in rural Australia is needed to provide
insights into management constructs for improved
service delivery including Aboriginal health
needs. Workers need to look at the perceptions of
indigenous Australians to their own needs for
allied health services and determine new models
for allied health service delivery in this context.
A large part of the Australian terrain, includ-
ing the beef cattle industry in western north
Queensland, is given over to stock grazing; there-
fore mustering goes with the terrain. However, the
work of mustering is matadorial in nature and
injuries are a routine feature of the occupation.
Therefore, throughout Australia it must be
expected that injuries from this occupation will
frequently occur, making physiotherapy services
a basic health need in remote and rural climes.
Improvements are needed to database collations
of injuries Australia wide to establish realistic
prevalence rates and, for purposes of prevention
of injuries, a capacity to relate injury and inci-
dent. In terms of primary health care, data needs
reflect the dynamics of injury so that it can have
relevance to local communities for producing
their own prevention strategies.
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