Tangible legacy

Professor Amanda Kenny, Director of the Violet Vines Marshman Centre for Rural Health Research, talks with Giselle Roberts about how we can boost equity and access in rural health

COVID-19 lockdowns and working from home have left tired Melburnians dreaming of greener pastures. In recent months, it’s led to a mind-shift – and a literal-shift in the form of a regional housing market boom – as many pack their bags and escape to the country.

While Professor Amanda Kenny is a champion of rural life and rural communities – “It’s a fantastic place to live,” she enthuses – she knows all too well that country life does not always lead to bucolic bliss. Instead, equity, access and inclusion issues are brought to the fore, especially when it comes to health.

“For almost every health indicator, the disparities between metropolitan and rural health are striking,” Kenny explains. “Rates of heart disease, cancer and mental health issues are higher in rural communities. And while all individuals should have equitable access to healthcare and should not be disadvantaged by their locale, it doesn’t always play out that way in rural Australia.”

Enter the Violet Vines Marshman Centre for Rural Health Research. Established in 2019, following a $3 million investment from the VV Marshman Charitable Trust, the Centre’s world-class research is narrowing the gap between metropolitan health outcomes and those in regional, rural and remote areas. It was an existing area of strength for La Trobe, but the Trust’s generous investment has been a significant catalyst, providing researchers with a platform that gives them wider reach and greater impact. At the helm is Kenny, Centre Director, an internationally recognised expert and longstanding champion of rural health.

Kenny is as personable as ever when we meet over Zoom and, as her dachshunds scurry through the kitchen, we laugh about the minor foibles of working from home. She might be an intellectual powerhouse, but she’s also grounded and community-driven, with a research agenda that is delivering practical outcomes to the people who need them most.

“The Centre is based upon the idea that the best people to drive change are the people who experience rural health service delivery on a daily basis,” she says. “It’s not about working on ivory-tower research and disseminating the findings. We are engaging rural people as equal partners, recognising the value of lived experience and using it to build capacity at the grassroots level, so that there is a real impact for a real person.”

It’s a sentiment that resonates well with Dr Neil Marshman, Chair of the Centre’s Advisory Board Committee and a founding member of the VV Marshman Trust. The Trust was established by his mother, Violet Vines Marshman, a nurse and philanthropist who “rolled up her sleeves” and dedicated her life to improving the health and wellbeing of people living in rural and regional Australia.

“Early on, one of my brothers said to Mandy, ‘Don’t forget about ‘Mrs Brown from a rural town.’ She’s your symbolic figurehead and, most importantly, your audience,’” says Marshman. “And that statement captures everything. That last mile connection, to a Mrs Brown, is about bringing better health service delivery back to the people and connecting communities in beneficial ways.”

But, how does this happen? “Let’s say that ‘Mrs Brown’ lives in an aged care facility in a rural community, where our researchers are working on an oral health project,” Kenny explains. “We may identify that the facility is not prioritising the oral health needs of its residents. Mrs Brown and her family may provide similar feedback. Perhaps Mrs Brown has dementia. She’s been crying in pain and losing weight, but no one thought it had anything to do with her teeth. But, as it turns out, it does, and perhaps a tooth has a cavity.”

“Next, we develop a strategy to improve oral health outcomes for Mrs Brown and the other residents. The facility may need to reassess their oral health practices, provide further staff training, or contract a dentist for regular oral health assessments. The family may decide to monitor this issue more closely.”

“Using more conventional research approaches, it might take up to 20 years to implement that change in Mrs Brown’s aged care facility,” Kenny adds, “but we’re in there working with residents, families and healthcare staff so that the changes are already happening. Those learnings are then disseminated through publications, and some of those findings might be applicable to other settings, where there are other Mrs Browns.”

This grassroots engagement, Marshman and Kenny contend, will transform rural communities from within and build a library of transferable knowledge that can be adopted by other people in other places. “It’s also about building research capacity within health services,” says Kenny. “Suddenly research is not something scary, but a set of evaluation tools that builds an evidence base. If we can build that understanding at the coalface, it will be both transformational and translational.”

The work has most certainly begun. Over 50 Centre researchers and Higher Degree by Research students are partnering with health services, community organisations and government on a range of projects that address some of the most complex and intractable rural problems: from improving the oral health outcomes of people with a serious mental illness, to telling the stories of rural women who have experienced domestic violence. “We are working, communicating and partnering to create understanding and change,” Kenny says.

Kenny hopes, most of all, that the Centre’s achievements provide sustainable recognition for the legacy of Violet Vines Marshman. “This Centre is funded by a rural woman who was committed to making a difference,” says Kenny, reflectively. “We are harnessing her passion for rural communities to ensure that her legacy is enduring and that our work helps to positively address the issues that impact vulnerable country people.”

Find out more about the Violet Vines Marshman Centre for Rural Health Research.

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