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Background Briefing – the mherv project.
mherv – ‘Men’s Health Education Rural Van’ is a Rotary project. It is a purpose-built caravan with two consulting rooms that has toured multiple centres in NSW since August 2017. It has a full time Registered Nurse who, with the assistance of local community nurses, will conduct health tests among rural men.
A potted history of mherv…
In 2008, Rotarian Tony Mackenzie began discussions with the General Manager of Western District Hospital in Mudgee, Joy Adams, about the incidence of late presenting, poor health events among rural men.
It was decided to try to screen middle aged and older men in NSW rural communities to see if simple tests could identify men’s health issues earlier, thereby bringing them to a doctor before otherwise treatable conditions became too serious.
With Joy’s help and that of Registered Nurse Andrew Whale, Rotary began by borrowing an old caravan, which they took to towns in the western districts of NSW. Eight towns were sampled including Narromine, Cobar, Bourke and Nyngan.
At first they discovered a reluctance by men to be tested. “I’m ok … don’t need that” … “She’ll be right” being the attitude used to excuse themselves from anything to do with their health. But as time and experience began to teach them, the team developed techniques to persuade men to be in it!
They discovered that many preferred their tests to be anonymous, so the registration form only asked for their first name and their telephone number. In the old caravan ‘clients’ could be seen through the window; drawn curtains prevented that when it was realised that too many passers-by in a country town would recognise people in the van.
Tony Mackenzie began doing interviews on radio and in the local press telling people “it’s a very confidential screening” … they would take away the results of the tests personally, with advice to see their own doctor, should the registered nurse see that a test indicated an issue. Later, they would be followed up with a phone call to see if they had made a doctor’s appointment. Quite soon, when the word got around that nobody was forcing anyone to do anything nasty, but that lives had been saved, more and more men were coming to mherv for their free, five-to-ten minute confidential tests.
Apart from head-counting, the team had not been gathering formal statistics. However as Tony Mackenzie says when asked what it was that convinced the team that the service was really needed. He said there were several times in different towns when the nurse one way or another contrived to get a fellow straight to hospital. Usually because their blood pressure was ‘through the roof’! On one occasion the RN declared that the ‘cuff’ (part of her blood pressure machine) had failed and that she would take him to hospital to get it checked … knowing that his BP was so seriously elevated that with any exertion even by walking to the hospital, he may have had a heart attack and died.
We don’t know how many rural men have already died suddenly for want of a basic health check or how many we will save on future trips. But people who have not seen their doctor for several years are in high numbers in rural areas. Many men just drop dead in the paddock, and nobody saw it coming!
Another serious illness may be discovered when blood sugar levels are tested. Many men in the country have diabetes which can be asymptomatic. Without a test, they may not know they have serious, yet treatable health problems looming.
In past years there were several other forays into the western districts of NSW. Later, using a rented caravan, which was a little more ‘up-market looking’ than the previous one which had almost fallen to bits being on country roads roads so regularly. At every stop there were more lessons learned about how to run the project to get best results.
In 2013 it was decided to commission a strong, purpose-built caravan to continue the work. It has two consulting rooms which have no windows so is completely confidential. It is possible for the unit to have two nurses conducting tests simultaneously. The caravan also has a refrigerator and air conditioning.
The new caravan went out a few times, mostly to events like agricultural shows and to one or two rural towns when people had time. Doing the tests were community nurses from Western Districts Health. They were not always available on weekends and holidays and because a single person was not dedicated to the role, there was little or no flexibility. It was difficult to plan anything more than short sorties into towns or venues not too far away.
Some of the volunteers working the project became busy with other priorities in their own lives, and mherv, (the new van) was stored on a property out west, awaiting its next assignment, or occasionally going out for an event.
It was clear that a new approach was needed. Steve Jackson, District Governor of Rotary District 9670 – 2016/17, was keen to see that the project didn’t quietly fade away. The new van was there to be used, and there was still some expertise and experience available from Tony Mackenzie. But there had to be another way, … to set the project up sustainably. Steve recruited Rotarian Adrian Payne from The Rotary Club of Warners Bay to come up with a plan.
Essentially the following points in the plan were decided:
1 There would be a full time registered nurse travelling with the project.
2 There should be a planned route mapped out for a tour scheduled within a 12 month period.
3 mherv should attend as many rural NSW areas as possible.
4 The Rotary clubs resident in towns along the route will support the project locally. They set up local hotel accommodation and meals for the RN, and provide a laundry service. They liaise with the local council, police and others for the van’s main-street or alternative parking, in places where rural men gather. Rotarians will staff the registration desk outside the caravan and work with the local media to gain publicity prior to mherv’s arrival.
5 Because this work is shared among Rotary clubs along the route, it isn’t an onerous task. Rotary clubs are always keen to have an opportunity to make a contribution in their own community.
6 A team of six Rotarians with appropriate expertise is managing the project. One is a retired Rural Medical Practitioner. With an RN he will oversee the testing procedures. Others will supervise the production of marketing resources like posters to be displayed in pubs and other public places. Stories and associated pictures will be written for use by local newspapers. Press releases and in time, even videos and a short documentary will be produced that can be used by local tv stations and be seen on YouTube. The management team will also supervise the constant updating of the website.
On the 24th August 2017, mherv headed out into the western districts of NSW. And after a Christmas/New Year break, visited closer coastal regions of the state, concluding the first tour in May 2018 in Wellington.
Statistics were be gathered along the way, in cooperation with the Hunter Health Men’s Health Unit, adding to their data base of information which is used to target better programmes for men’s health generally. They already share information in a Men’s Health Network throughout Australia.
Hopefully, while rural men don’t find time for check-ups, this history is going to become a never-ending story. Rotary across the world has almost eradicated polio from the face of the earth. mherv’s tyre-tracks may yet be seen in other states of Australia, and perhaps beyond.
The Royal Freemasons’ Benevolent Institution has generously donated funds to cover the salary of the Registered nurse up till 2022. The NSW Premier has donated funds that will help Rotary with expenses.
Note: mherv still needs to raise funds to cover running costs, maintenance and the replenishment of medical testing consumables. On the website home page a “donate” button for those wishing to make a contribution.