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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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World Health Organization. Report on the Proceed-

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