10 tips on navigating the new world (of constant video meetings)

I’ve been suffering through video meetings for many years now. it is one of the joys of being a remote professional worker. A large part of my non-clinical work experience has been working from home and videoing in to meetings, presentations and seminars. I’ve chaired meetings, I’ve presented lectures, I’ve lost my connection mid-sentence, I’ve lost my mind over video. Here are my ten tips on navigating your new overwhelming slew of video conference engagements with the panache and skill of a pro.

1. If you are not speaking, mute your microphone. For the love of god: please mute. Now. No exceptions mouth breather.

2. When you are speaking. Un-mute your microphone. Otherwise you look like a tool, screaming in to space.

3. Make sure there is some light on your face. Otherwise you can look super sinister, or like you’re in witness protection.

4. Pants aren’t obligatory, but recommended. You never know when you’ll have to stand up and chase something out of the room. Dog. Child. Bat. 

5. Hats are fancy and you should wear them. If you don’t have a hat, wear a costume. If you don’t have a costume, download a webcam filter app.

6. If its a group situation, and you want to speak – raise your hand until someone notices. If no-one notices, start yelling. Or make this noise:

7. Don’t speak too fast.

8. There are hundreds of different platforms. WebEx. Lifesize, Zoom, Teams, Hangouts, Skype, Skype for Business, Skype for Leisure. They are all terrible. That’s why we use so many different ones. Someone always has a favourite one. Just defer to the biggest fan. We get it Karen, you have a Zoom subscription and you’re a super user. Whatever.

9. If you are in the big room with the microphone on the table – be aware that sounds can come through the microphone (tapping, sliding food around, or you sighing in exasperation) Try to stay still and quiet, like you are hunting a wildebeest in the wilds. 

10. Don’t worry about stuffing up. No-one is that good at this stuff. That’s why we don’t use it all the time. Some people are better at it than others. Its not a competition.

Do we actually want violence against women to end?

Men get pushed in to doing things. A father can’t see his children as much as he wants to and is left with no choice but to lash out.

We don’t know what happens behind closed doors. Who really knows what their relationship was like behind the scenes. Women can be manipulative – or she might not have been faithful! People need to understand that fathers feel pain. And that the law courts punish fathers. What options are left to men? Its no wonder. Its clear: violent public murders are really the only option left.

What a world we live in when people’s first response to domestic terrorism is to absolve violent perpetrators. They are good guys. Great blokes. Violent murder is violent murder. Violent murderers are not good blokes. The man who violently murdered Hannah Clarke was a violent murderer. A “good man” did not “snap”. A man escalated his violent and controlling behaviour. A man chose to immolate his children in a public place, rather than share custody of them. A man chose to violently murder his ex-partner rather than move on. A man chose to violently kill himself rather than face the police. A man chose to strike terror in to the public. This was not a moment of weakness, this was an escalation to act of violent extremism. Of intimate domestic terrorism.

This man’s violent act has irrevocably damaged the lives of the witnesses that looked on in terror. The neighbour who valiantly tried to rescue the three children in the back of that car will never un-see their faces. The brave neighbours that rushed to Hannah’s aide, despite the physical threat of the nearby violent terrorist will never un-see her burns. No one rushing forward knew what this man was planning to do next – their bravery was incredible.

The emergency service personnel that responded to the scene will never forget what they found. All of these humans will never un-see what they witnessed. Never un-smell what they smelt. Un-hear the screams. They will be haunted by the actions of this violent man. Simple things will be forever changed: the smell of petrol, the crackle of fire, the street they live on, their homes, their lawns, their lives. Their lives will never be the same.

Survivors of other violent men will be dealing with flashbacks of their own past. Their own mortality. Their own guilt for escaping. Those still searching for a way to escape their own violent situations will see this as a warning of what could happen. It makes their fears very real. The Australian Government defines a terrorist act as an act that intends to coerce or influence the public to advance an ideological cause by causing death. This violent man’s actions will have influenced the public. It will have reminded those trapped in relationships with violent men that they face the very real threat of death if they leave. The ideology that men can be pushed in to violence has been advanced. The belief that women can force a man to violence through their actions has been advanced. Women have been reminded of what happens if they leave: that they will not be safe.

This violent reminder was reinforced by the Queensland Police. Their spokesperson’s comments that there can apparently be “two sides” to a violent act that struck terror in the hearts of our nation when a father set fire to his children reminds women of their place. This critical reinforcement that men can be “pushed” to murder reminds women, the most vulnerable women in our society, that their safety can not be guaranteed and that they may even be blamed for their own murders. How do you escape a position of terror and fear if the agency that you will most need help and protection from all but defends public acts of terror on our streets? Where are these women supposed to go? Where are we as a society supposed to go? Why do we need an “open mind” when a human is set on fire in a suburban street?

We reached a critical point on this issue years ago. The violent death of Hannah and her children should not surprise anyone. This continuation of violent acts by men is the status quo. Hannah will not be the last women to die violently at the hands of a domestic terrorist this year. Women will continue to die and we will continue to be sad and we will continue, as a society to do very little about it.

Our government has reduced funding for shelters that give women fleeing violence somewhere to go. Our police defended this situation, suggesting there were two sides to the story. Our media portrayed this violent murderer as a former football star. Our society questioned what went on behind closed doors – as if there is any act of domestic disharmony that permits public immolation of women and children. We treated a few needles in some strawberries with more conviction that violent murders.

Our society effectively condones violent domestic terrorism through inaction and ambivalence. What are we actually going to do to stop this? In a months time will we remember Hannah and her children as the moment we stepped up and created change – or will she be just another dead woman?

I’m at the point of despair on what to do next. Seriously – what the hell do we do to stop this. What can I do personally? These aren’t hypothetical questions where I next paint the picture of my own smug action: I’m lost. I’m confused. I’m angry. I’m sad. I’m upset. I want to tell my kids this kind of stuff will stop. I want to know my friends are safe. I want to know that men will stop killing their families. I want to know there is an end.

Sadly, the only thing I do know is that these violent intimate domestic terrorists aren’t going away any time soon. Not while we apologise for violent men. Not while we refuse to get uncomfortable. Not while we refuse to change the system. We can demand that there is an end – but I don’t know how we actually get there. I know there is a framework for action. I know there is a path. I know we could do it. Just not while we keep doing what we are doing.

  • 1800 Respect – Confidential information, counselling and support service
  • Our Watch – has been established to drive nation-wide change in the culture, behaviours and attitudes that underpin and create violence against women
  • Share the Dignity – Donate to a women’s charity that makes a real, on-the-ground difference for girls and women experiencing homelessness, domestic violence and period poverty.
  • Chorus – A massive dance project calling for end of violence against women. Check out the documentary here
  • Lifeline – Lifeline is a national charity providing all Australians experiencing a personal crisis with access to 24 hour crisis support and suicide prevention services.
  • eheadspace – eheadspace provides free online and telephone support and counselling to young people 12 – 25 and their families and friends.

Review: The Presence of Wool

REVIEW: The Presence of Wool

Brave New Works 26

Review Performance: 2 November 2019

By Carl Heslop

The Presence of Wool was remounted at Denmark Arts Brave New Works #26, allowing audiences the chance to see Sym Parr’s contemporary dance work one more time. Premiering earlier this year in a shearing shed, The Presence of Wool was adapted to the Denmark Civic Centre with a few line-up changes allowing some Denmark cameos. The Civic Centre lacks the atmospheric elements of its original setting, but this remount still provided an intriguing and engaging experience. The Presence of Wool was performed as the closing piece of the Motion Triptych trilogy of works alongside John Carberry’s film Ameliorer Resolve IV and Nari Lee’s Waterways.

The dance piece wove complex gestural patterns with machine-like characteristics together with a softness in costume and lighting and the signature complexity of James Gentle’s soundscapes. There was a worker-like intensity to the task at hand, from ensemble as the piece evolved from mundane workplace interactions and homages, to the rituals of the mill, to frenzied entanglement and then ghostly dream-like sequences.

Photo: Nic Duncan via Facebook

The Presence of Wool opened to a projection of the woollen mills on the backdrop screen and the echoes of the past provided by tales from workers of the mill, delicately entwined with Gentle’s exploratory sounds. The core ensemble, dressed in costumes nodding to the 1950’s, move across the stage organising, chatting, interacting with nonchalance and a lack of urgency, before forming into machine-like spooling and weaving. Jessica Hesford and Rita Bush are central within the ensemble through this early piece, with transfixing accuracy of movement and presence.

Pic: Tasty Beacon via Facebook

The youth contingent takes the stage to further highlight the presence of wool, from their beautiful patchwork costumes to the tangled spools of wool, the group collect and wrap around each other until one single dancer is wrapped, web-like in the wool. A dramatic and precarious solo of struggle with a soundscape of rising desperation. For the duration of the solo I was convinced one of these strands of wool would bring down the dancer, watching on with trepidation and hope until the choreographed exhaustion and struggle was what brought them down.

Pic: Tasty Beacon via Facebook

From the quiet dripping water and frogs in the soundscape, a cocoon emerges in front of us. Obscured in plain-sight by the proceeding action and intensity, this creature is suddenly alive and moving. Flexing and straining with a visceral quality, limbs appear and disappear until the quivering object releases a dancer who takes flight.

The intensity rises as this almost beautiful creature begins to rhythmically thrash. Encapsulating the incredibly talented Bush, the patterns and shapes this being was able to generate through its movement was thoroughly satisfying visually. Despite knowing there was only one dancer left inside, there were moments it took shape to suggest there were more; the combination of costume and movement tricking the brain.

Pic: Tasty Beacon via Facebook

The Civic Centre lacks a little in ambiance and atmosphere, and some technical difficulties popped up, but the cast were committed to doing the original season justice in this remount. The Presence of Wool was transfixing and intriguing. There were moments of uneasiness and uncertainty, wonderful interplays between the soundscape, choreography and the wool costumes. There was a sense of satisfaction in the experience and I left still thinking about that multi-limbed creature and its ability to hold ghost dancers within it.

This review was published in Denmark Bulletin No. 995 November 14 and is reproduced with permission. Thanks for the support Denmark Bulletin! You can check out their latest edition here

The Author of this review paid for their own ticket to the performance and was not paid to write this review.

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Review: Waterways

REVIEW: WATERWAYS

Brave New Works 26

Review Performance: 2 November 2019

By Carl Heslop

Waterways is a community contemporary dance work created by Nari Lees that was performed in the Denmark Civic Centre as part of the Denmark Arts Brave New Works #26. This work builds on Lee’s previous work on the Waterways project and Global Water Dance in June 2019, and developed choreography with community members. It was performed as the opening piece of the Motion Triptych trilogy of works alongside John Carberry’s film Ameliorer Resolve IV and Sym Parr’s remount of The Presence of Wool.

Waterways brought large numbers of community dancers of all ages together to explore their connection with water the frictions and energy within that interaction.

The work captured lived experiences of performers and built a multilayered performance that incorporated high quality video, an original audio score, voice and song, and a multitude of movements to offer a rich and immersive environment. The complex soundscape created by Jeremy Hick and Marlu Harris changed and progressed through the performance; melodic at times, discordant at others, but always intricate and layered.

Anne Sorenson. Photo: Shoon Arts

The performance opened with the wide sand plains of a dry Denmark Inlet projected onto the background screen accompanied by Anne Sorenson sliding down the specially constructed wooden ramp, plunging us into the experience.

Lees used complex, yet subtle staging techniques within Waterways and played with the established stage and set design by augmenting it with reflective materials, a projector screen that doubled as a shadow screen, hanging and loose fabrics. The wooden ramp cleverly connected the raised stage and floor and was used regularly through the performance to transition dancers.

Groups of families with small children delivered individual scores that spoke to the water theme, coming onto the stage to briefly deliver a vignette or snapshot of a memory, before flowing off stage and being replaced by the next wave of performers. There were moments I yearned for a family group to linger longer but would be endeared to the next group as they appeared.

A combination of performers, a community, parents and children. Photo: Shoon Arts

The main ensemble worked through various movement scores, walking patterns and echoes of the family scores that showed clear connection and flow to the watery theme. There were moments of synchronicity and moments of syncopation that were clearly reminiscent of the relationships between ripples, waves and swells.

The ensemble was a collection of new and familiar faces to the Denmark dance scene, with all displaying a strong commitment to the task at hand within their own talents. Marie Kerr provided a strong stage presence within the ensemble with equal parts technical ability and charisma, while Tanya Garvin’s monologue was powerful and moving.

A youth ensemble that has worked with Lees for several years delivered a tender and engaged score utilising a large sheet of fabric that rippled and fluttered with their movement. This section highlighted the group’s development and demonstrated a bold step away from familiar bombastic movement languages and into a more considered dance style.

Waterways worked its way through the multitude of scores before winding down from swirling walking patterns, to movements showing the vulnerability of the ritual of washing, before a tinkering and melancholic soundscape brought the ensemble together in a touching embrace.  

Main ensemble. Photo: Shoon Arts

Waterways was a brave and immersive experience. Melding complex ideas, images and components together in a single community dance performance with such a diverse cast certainly constitutes a brave new work, and Lee’s commitment to inclusivity is a strength of her practice.

Vulnerability, power, playfulness and connection were on show throughout and Lees should be proud of the production quality of the performance and its dancers.   

This review was published in Denmark Bulletin No. 995 November 14 and is reproduced with permission. Thanks for the support Denmark Bulletin! You can check out their latest edition here

The Author of this review paid for their own ticket to the performance and was not paid to write this review.

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The original publication in the Denmark Bulletin

A Rural Voice: SexRurality 2019

My trip to Victoria two years ago to attend my first SexRurality conference in Lancefield was invaluable. It took me out of my bubble here in the West and reassured me that there were clinicians, practitioners and researchers experiencing similar frustrations; eager to find solutions to common issues and struggling under the constraints of the rural sexual health sector. I was so excited to head back to Victoria; back to SexRurality and in some ways, back to my people this year in Creswick.

Creswick. Beautiful Creswick.

Where the hell is Creswick, you ask? You and everyone I spoke to about SexRurality before I left. The look of utter confusion on everyone’s faces reassured me that I was heading to the right place. What better setting for rural health focussed conferences than towns that no-one knows about? Or has driven through once on their way to somewhere bigger and better. Creswick was perfect.

Day one: Get political, get connected

Creswick is found on Dja Dja Warrung land, and Rick Kerr was charged with Welcoming us to these lands. Rick is an Elder and a direct descendant of Leonard Kerr, a Dja Dja Warrung man born at Mount Hope in 1854. He spoke to us about the dreaming stories of the area: of Bunjil Dreaming and the actions of the Raven, the Cockatoo and the Rainbow Serpent. Rick spoke of the passing of knowledge and learning through the ages; how the Dja Dja Warrung “danced their stories in to the fire”. We were welcomed to this country – and ready to begin.

Marie Bubnic provided the conference opening on behalf of the Department of Health and Human Services (VIC) and highlighted the number of demand pressures that are felt within sexual health and reproductive health services provision.

There was an acknowledgement of something that rural workers and researchers understand intimately: that rural service provision is often personnel and personality-based. The doctor in a rural town impacts on what services are available. Marie also spoke about how there was a lack of service integration, and that while cost and travel are significant barriers, the Department had found that rural people are more than willing to travel for services that are inclusive and de-stigmatised.

There was also recognition that current funding and structures are focussed primarily on specialist service provision, and that a transition to more place-based primary care was a challenge that will require collaboration with the sexual health workforce. A subtle plug that Health Promotion must be considered within this attempt to reorientate health services is inserted here.

Kylie Stephens, the Senior Health Promotion Manager at CERSH, gave us an update on what was happening in their world, what they were proud of and the areas CERSH needed to pay attention. Kylie discussed the potential to increase the geographical reach of CERSH while also ensuring that we, as the rural sexual health workforce, continue in our efforts to broaden the responsibility of prevention efforts.

In settings where resources and power are contested, there is a need to ensure that rural voices are provided and heard – and that localised solutions and community participation are important in the rural setting. Kylie also highlighted the need to address workplace attitudes and cultures: practitioners and workers learn that sexual health lacks priority and focus from their peers. So much of this overview resonated with me that it pretty much reinforced why travelling across the country was such a good idea this time, and last time.

When someone says something at a conference and you feel vindicated.

Next person to take the lectern was Fiona Patten MLC. Now this isn’t your usual local member address. As the Member for Northern Metropolitan Region in the Victorian Parliament’s Legislative Council, Fiona has been called “Australia’s most effective legislator.” Her legislative achievements put many of our far longer serving elected representatives to shame and her ability to hold us as a crowd was very impressive as she talked about “How do we get politicians to say the ‘S’ word?”

Fiona talked about her engagement with politics before becoming elected and how she went about engaging politicians in ways that aren’t possible now. Fiona spoke of a time when politicians were brave, such as attending a sausage sizzle at a brothel for Open Brothel Day when it coincided with Safe Oral Sex Day. I fear those days are gone. It was also highlighted that sex workers have a strong role in sexual health promotion as educators and should be respected as a resource.

Very, very grateful to return from Crewick with this wonderful souvenir

Fiona highlighted what we know: access, stigma and confidentiality are key determinants underlying rural sexual and reproductive health. Now, just because we know it – it doesn’t mean it isn’t nice to hear someone else acknowledge it. It also flowed in to one of the key takeaway points for me from SexRurality 2019: that we need to talk to our politicians about sex – before they start talking about it. And we, the 150+ people in the room were a clear directive and call to action: go talk to our politicians. Talk to them about the issues in our local areas. Tell them our stories. Go with actions and solutions. We are excellent sexual health communicators doing the best that we can – so we need our politicians on OUR side, advocating and lobbying for OUR needs. They can’t do that if we don’t communicate with them.

“Talk sex to your politicians.”

Go to them. Tell them your stories from the field.Go with action and solutions.

Next up, was Associate Professor Christopher Fisher from the Australian research Centre in Sex, Health and Society giving us some rural focussed findings from the 6th National Survey of Secondary Students and Adolescent Sexual Health (research protocol here).

It was brilliant to get the rural focus on these findings and it generated a lot of discussion on why some things were seen in the data. Rural young people were more confident in using sexual health services – and somewhat more trusting. This is something I’ve seen within my own research, where young people did not feel the same level of anxiety over confidentiality concerns accessing rural GPs as the rural GPs themselves felt.

Young people wanted relationships and sexuality education that was real and useful. They did not want tokenism. Findings highlighted the massive burden that young women bear in terms of provision of informal relationship and sexuality education. It’s great that peers are seen as one of the best places to turn to for advice – but how are we supporting these peers?

We then broke for what seemed like the first of several hundred meal breaks and our first real chance to network. I’d been beating off a sore throat for a few days before travelling and was seriously worried I’d lose my voice before I presented on the second day – but there were far too many people to catch up with and talk to. Oh, and some networking of course.

Inigo Montoya’s guide to conference networking

We came back from break to a panel discussion facilitated by Yumi Stynes, the host of one of the best podcasts going around (go listen to it now!). I think Yumi is pretty cool and I can safely report that I (and a few dozen other delegates) totally kept it together after lunch and didn’t descend into pools of pathetic fan-boy/fan-girl/fan-nb behaviour.

Anyway, cart before the horse – before I embarrassed myself, Yumi facilitated one of the most diverse panels I’ve ever seen at a conference. I don’t want to list the ways in which this was achieved in some diversity checklist/shopping list – but let’s just say there were a lot of boxes ticked and a lot of amazing perspectives.

The thing that hit me very early on in the discussion was how a number of the panellists had been failed by their health professionals when seeking help. From a young trans-person being told they were insane, to a pregnant women with genital mutilation being met with overt fear and stigma, to terrible management of a new HIV diagnosis.

The panel was incredibly brave in what they shared with us and were candid in their responses. Yumi asked the panel what they would like to see included in relationships and sexuality education in schools: they were queer inclusivity, pleasure, abortion, understandings about cultural sensitivities, respect, the need to love yourself first. Nothing shocking – but enough to send a politician scared of gender whisperers into a tizz no doubt. These are not the political times of brothel sausage sizzles.

In closing remarks, Yumi encouraged us to get out there and consider podcasting to communicate what we are up to. Expect a heap of sexual health podcasts coming your way – hell, one even popped out of here! We then broke again for food, the chance to network, and the chance to embarrass ourselves at the feet of Yumi. We launched at those three opportunities with gusto.

Split sessions

After food, we started the first of the split sessions. Conferences always present dilemmas on who to see; who to miss. It brings me back to my early days going to festivals when I would scorn the organisers for putting Machine Gun Fellatio and Shihad against each other. Do I choose provocative on-stage antics or power rock?

Now, I’m not going to say which one was which, I’ll leave that to your interpretation – but I started in the Open Topics stream with Shannon Hill and Siobhan Bourke, before racing across the festival conference to the Place-Based Stream to catch Amy Isham, Cath Tischler and Bernadette Lewis.

Shannon Hill started with a strong question asking ‘What good intention we could put out in our work and make come back to us?’ before presenting on the great work that Women’s Health Grampians had done in developing a Theory of Change – a pathway towards a vision. The Theory of Change was about plotting the way to achieve the vision clearer, thus creating supportive environments and setting foundations for future progress. I liked it. Siobhan Bourke gave a great overview of the Sensitive Physical Examination Program used to teach medical students how to negotiate sensitive examinations. Consent and feedback are key components that students learn – as well as important feedback on body language and how they interact with patients. There was also the great point that we presume medical and nursing students have had great relationships and sexuality education in the past – when often they haven’t.

Across town, Amy Isham and Cathy Tischler gave an overview of how their ethnographic research is embedded alongside (under?) an active participatory action research project to provide deeper understanding of the issues relating to social service delivery and access faced by teenage parents in Horsham. Another great example of regional researchers in a regional area finding local solutions to problems – that will no doubt have value to the wider population. They highlighted the need to address the gaps and ensure that the real world practitioners know as reality is expressed within the research literature. One point Cathy made that ties back to Fiona Patten’s call to action was that politics influences health at all levels and there is a need to empower our regions as a whole. Bernadette Fraser rounded out the session giving an overview of the Storylines project – a collaborative project that gathered women’s lived experiences that highlighted intersections between social determinants, health inequities and barriers to access.

The beautiful paperback vulvas made by BlackGin

After lunch, Edwina Jachimowicz, a fellow out-of-towner presented on a program that SHINE SA had implemented to build workforce capacity within the rural and regional workforce. The project came about from the knowledge that the sexual health workforce is expected to do as much, if not more as before, with the same or less resources. This brought about the need for a partnership approach. This involved negotiating some turf wars and managing expectations but led to considerable knowledge gains. Next up was Jenny O’Connor from CERSH, talking about working with LGAs in trying to install condom vending machines. Now this is something I know about from my area – I’ve been laughed at for suggesting condom vending machines in our area – and as a Councillor as well as a Health Promotion worker, Jenny has a foot in both camps. Navigating very local politics still needs advocacy, nuance and hard work.

Dr Tim Staunton Smith presented a really nice project on the physically-visible and Web search-able signs that rural GP practices are LGBTQI friendly. It was not the most complicated study – but it did what it was designed to do and I’d love to replicate it here in rural WA. Interestingly, in the days after the conference while in Hamilton, I noted several shops and cafes had Rainbow Flag stickers on their doors. It was subtle. It was simple. I don’t know anything about it – if it’s a local scheme – let me know.

Hamilton and the subtle Rainbow Flags

And well – from there, I tapped out for the final 30 minutes and found somewhere quiet to gather myself. Conferences can be really full-on – and with an evening drama performance and dinner ahead – I needed a quiet moment. It wasn’t quite a Bex and a lay-down, but it was close. I followed the Twitter hashtag as I rested, and was again reminded of how useful Twitter can be. Yeah, it can be a waste of time – but #sexrurality was trending locally. I had a heap of interactions from both people at the conference and around the place, and I knew when I got home to write this there would be something to work with. About five years ago, I wrote a little thing for Croakey blog after the PHAA Conference in Perth about joining Twitter. Have a read and a think if you are still to be convinced.

I’ll be honest – I had gone to the chill-out tent for this one. I was cooked, but still followed along via Twitter.

Before we were unleashed on the conference buffet, we were treated to an early showing of ILBIJERRI Theatre Company’s VIRAL. Director Kamarra Bell-Wykes reminded us that the cast were still in the early days of settling into rehearsal and not quite ‘show ready’ – and for us to be kind. This was more of an open rehearsal than a full show.

What followed was gritty, stark and determined story-telling that delved into the realities of health care access, discrimination and colonisation, and the ongoing impacts on the social determinants of health. The sharp and witty dialogue was often split across the three performers (Jessie Butler, Shannon Hood & Nikita Tabuteau) to create power in shared messaging.

It was a raw performance – but a fantastic one. It was great theatre and wonderful to see art and health coming together. Since the last Sexrurality, I’ve gone on a bit of an accidental arts/dance adventure and I think we need to work harder to find synergies between the arts and health – both in terms of messaging, but also advocacy and sharing of ideas and resources.

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Day two: Research, presentations and farewells

I awoke as fresh as a daisy and ready to take on what was going to be another big day of rural sexual health. Today was game day for me – and I could not have asked for a better preparation. It was time to get caffeinated, get excited, warm up our Twitter fingers and get back into it.

Well, SEX(ually transmitted infections anyway)

Associate Professor Eric Chow kicked off the day with what was new in Gonorrhoea control. This was a pretty epic presentation that I’m not sure I can wrap up that easily. From the question of “Can you use saliva as lube for anal sex?” (You can, but should you? The prevalence of gonorrhoea in MSM who did use saliva was greater than 2 times the prevalence in those who didn’t), to exploring if mouthwash can be a novel treatment for oropharangeal gonorrhoea (or dandruff*) – there was a lot of content covered. What is clear, is that with gonorrhoea on the rise – we need to pay more attention to some of the unrecognised risk factors in transmission.

Professor Jane Hocking was next with a focus on Chlamydia Control. Jane asked us about our current practice and if it was evidence based – our focus tends to be on promoting increased testing – however, this doesn’t necessarily reduce the incidence of Chlamydia and ultimately we want to prevent Pelvic Inflammatory Disease. But PID isn’t monitored. Perhaps we need more of a case management approach to reduce reproductive morbidity and minimise reinfection.

Also, with rectal Chlamydia being detected at increased rates in women – is it something to worry about? Literature shows there is 32 fold incidence in women testing positive rectal infection with urogenital infection. Contamination? Problem? Auto-inoculation? Its unclear. What is clear though, is that Chlamydia vaccine development needs to be a priority if we want to effectively control Chlamydia at population level

Dr Kathryn Cook started off telling us about St Denis, who I have to say, sounded a little bit like a late night conference delegate. St Denis was beheaded. Refused to die. Walked off carrying his head. Then died. And is the patron saint of syphilis. We all reach different heights. As wild as this was – Kathryn wanted to remind us that Syphilis is NOT history. We need to be kind contact tracing, we need to be diligent, we need to understand that even “nice ladies” that got to private clinics for IVF might have STIs. Congenital syphilis is not to be messed with.

After the break and just one more cake, I swear, Anne Roseman hit the stage with an intro song (I wanted my own stage entry song) to talk about Aboriginal Community Controlled Health Organisations and the work they are doing in sexual health. We also heard from Belinda Payne, Tara Purcell and Peter Wapoles-Crowe on their perspectives, involvement and insights. They highlighted that there are thousands of things to be done and sexual health is just one of them. There is under-reporting of STIs – most likely due to stigma and shame – and that universal screening is the key to reducing that shame. ACCHOs are also better placed to do holistic health care – but the FTE provided for sexual health is ridiculously low. Also, being aware of the intersections of gender, sexuality and culture cannot be ignored.

We then got more art in our face with the hilarious Alyce Fisher. It started with dancing condoms and ended with the charming word smith, Cameron. Again. Art. Health. Together. So happy. And safe:

Totally normal for a sexual health conference

Split sessions

Before lunch, we split again. Some went and engaged with the MoCCA Project as they ran a session about strengthening Chlamydia management in general practice; while the attention-seekers of the conference headed across to participate in an interactive creative development theatre session with ILBIJERRI. No guessing where I went. We worked hard in the theatre group, and all tried our hardest to be respectful of other people’s creative ideas when ours were clearly better, and came together to produce some really pleasing and thought-providing images through our dramatic staging. I hope ILBIJERRI got half as much out of it as we did.

There was time for one last buffet onslaught before the final split sessions – rural research and abortion care in the rural setting. I was at the research stage for that full set – so apologies for the lack of abortion care round up – but I was able to catch Pamela Doherty, from Children By Choice (another out of stater) talking about the barriers and facilitators that were faced in delivery of Medical Termination of Pregnancy (MTOP) in rural and remote Queensland.

Pamela Doherty

Marieke Dam presented the comprehensive approach taken from Women’s Health Grampians within their Increasing Reproductive Choices project. This was a great example of how you must address multiple socio-ecological and service levels to be effective – your approach must encapsulate top-to-bottom. It starts with the public facing front: it’s important that health centre reception staff have training in how to handle inquiries about accessing MTOP. Something I found fascinating a couple of days after the conference, while on a tour of the Budj Bim National Park, was learning that the Gunditjmara people had used green kangaroo apples to terminate unwanted pregnancies. This was normally when there were incoming harsh seasons and there would be pressure on group in terms of nutrition and health. It seems MTOP has been happening in rural Victoria, on country for a very long time.

Green Kangaroo Apple – used to terminate pregnancy

Dr Cameryn Garrett delivered on the impact evaluation of nurse and midwife contraceptive training. A lack of a Medicare rebate and supportive policies and procedures are barriers to nurses being able to insert contraceptive implants, and must be addressed – regardless of the training. Lily Claringbold presented on research into the factors influencing young women’s contraceptive choices, with fear relating to side-effects and pain, and invasiveness as major potential barriers for the low LARC uptake. Overall, there were many reasons women choose to use a particular contraceptive method, beyond contraceptive effectiveness, and they often make these decisions before speaking to their GP.

Marieke Dam

Is was then my turn to speak on how I accidentally became a PhD candidate how I got over-involved as a volunteer in trying to solve some sexual health problems within my own community. I was lucky enough to deliver effectively two presentations: one on the Delphi methodology that I utilised to validate the framework for sexual health provision in the rural area, and the second on the four key factors that the framework suggests. I realised as I hit the lectern that there was no presenter’s screen for me to look at – and as someone that tends to use the slides as prompts, rather than write a presentation – it made things a little trickier. Oops. Few tense moments.

Fundamentally, the presented framework suggest four key pillars for rural sexual health promotion from the research: we need to be providing credible and consistent relationships and sexuality education to our young people; ensuring that health services are well-connected and accessible; making sure condoms are easy to get and if possible – free; and building collaborative networks amongst traditional and non-traditional youth sexual health stakeholders. In many ways, it’s what people on the ground already know and do day-to-day. This project was about providing evidence, structure and guidance – not just pointing out what should be done. Hopefully it’s useful.

Anna Roberts presented some more exceptional rural research done by rural people explaining their project’s focus on mapping access to emergency contraception and MTOP – not just in terms of pure service access- but also availability or restriction of medication. Madeline Lim then presented about the artist formerly known as the Condom Fairy: a project that saw university students delivered free condoms on campus. The Condom Fairy was ranked the most convenient way for students to access condoms, and has been since renamed the Safer Sex Program. Finally, Jess Wynn brought us home with her research project asking “Do patients prefer a male or female urologist?” The thing that really resonated with me was that patient preferences are dynamic and open to change – a positive interaction has the potential to alter previous considerations. In my previous life as a nurse that happens to be a male, I would suggest that this research replicates my lived experience.

Wrapping up

There were some fantastic presentations this year at SexRurality, but one of the best things about this conference is the collegiality. People want to chat, they want to find out what you do and they want to share what they are doing. It’s an environment of support, encouragement and collaboration. Last time I attended, it was a real boost to my PhD in terms of validating what I was doing and reassuring me that people actually did care. This time around was a similar sense of validation and support – and I always speak highly of SexRurality to my WA-based colleagues. We just need a few more to come next time.

Star studded line up – can’t wait for the next one

In the days after SexRurality, while driving around rural Victoria checking out the Ballarat’s St Patrick’s Cathedral (timely), Grampians (amazing) and Budj Bim (incredible) – I reflected on the wrap-ups. So many fantastic points – but what was my take away? It took me until the flight home to settle, but I really agreed with Shannon Hill’s presentation and Jenny O’Connor’s interpretation of it during the wrap-up. I then kept reflecting on Fiona Patten’s call to action to engage our politicians. Finally, from the research stream, I agreed with Meredith Temple-Smith’s summation of the session – the need for strategic change.

My take away from SexRurality in 2019 is that we need a clear vision for rural sexual and reproductive health. A vision that includes strategically broadening the responsibility of prevention efforts beyond traditional stakeholders and fostering collaboration while championing reform to policy and appropriate resource provision. There are thousands of things to do, too few people and FTE funded positions to do them – but keeping on our current pathway there will be little change. Frameworks, mapping, systems approaches and solutions are the tools we need to strategically advocate for change from our policy makers. We can’t discount or neglect the amazing work that is happening in the field, but if we don’t collect the evidence, and more importantly, hand that evidence to our politicians on a silver platter – they aren’t going to find it before they start talking, and more importantly, deciding about sex.

So, that leaves me at the end. To finish my PhD. To make an appointment with my local members about my framework. To be a little bit more annoying. Oh, and to enrol to attend ASHM. What are you going to do?

Listen to the Southside Grind podcast about Sexrurality here

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What even counts?

I read a great book this week that got me thinking about penile-vaginal sex. Not in that way, you seedy beast, but in how much it rules what we do in terms of sexual health education, societal norms and perspectives.

at all good bookstores…

Please note – I’m going to use the term penile-vaginal sex a lot. If that makes you feel uncomfortable – I want you to know and understand that I could not really care.

Karley Sciortino’s book Slutever is part memoir, part sociological critique of gender and sexuality through a sex-positive lens. It is not for the faint hearted and not a perfect book – but I really enjoyed some of the questioning moments in the book. I particularly enjoyed the section on what is sex and what isn’t. It is something as a researcher I think about in terms of education and information. Its a fascinating thing we’ve constructed as far as our societal definitions and cultural norms.

As a society, we place such a misguided amount of weight around penile-vaginal sex. It is what “counts” in losing your virginity. It is all all our relationships and sexuality education in schools often dares to focus on. Sciortino talks about how it is often the “goal” in sex between cisgendered heteronormative couples. Its great fun, but is it all that sex is? We’ve been having different types of sex since time began, but rarely educate on it.

Within my own research (as in, published scholarly, not google/wikipedia), young people voiced a desire for relationships and sexuality education that acknowledged same-sex attraction as well as diverse sexuality – and they wouldn’t mind some information that they actually need. (gasp) In another paper about to be published in Sex Education, stakeholders I spoke to who deliver sexual health promotion in the community, either as a job or as accidental experts – also talk about the need for education that is relevant and meets young people’s needs [edit: it is now published. read it here]. There is also a fair bit about being afraid of stigma and backlash – but both groups agreed it needs to be more than cross section diagrams of genitals.

So much of our relationships and sexuality education focuses on biology. It targets penile-vaginal intercourse with laser like intensity. Heaven forbid we acknowledge that sex is much more than that. God only knows what would happen if we acknowledged in our education that lesbian, gay and bisexual people have sex that may not involve either a penis or a vagina. Or that penile-vaginal intercourse is just one way to get off. I know the sky would fall in if we delved in to the pleasure zone, so lets keep things functional for now.

We could start by looking at what young people are actually doing. We, as a society could acknowledge that more than 50% of young people in years 10 to 12 have received oral sex (surveyed as part of the 6th National Survey of Australian Secondary Students and Sexual Health). Or that 50% have given oral sex. Or that 65% have already been off touching genitals and/or having their genitals touched. Experience in penile-vaginal sex comes in a lowly 44% of all genders. So what counts as having sex? Does oral sex? What about a hand job? What information is important?

If we think of sex in purely pro-creative and biological terms – of the young people surveyed, 66% were still virgins. And their future partners will be so happy to hear that. Or something. No one wants to marry a sullied “non-virgin”. So with that in mind, how do you lose your virginity if you are gay, lesbian or bisexual and only engage in same-sex relationships? Are you always a virgin, regardless? Frozen in time.

barf

Maybe all these young people are just saving their “Technical Virginity” by giving handjobs, having oral sex and anal sex. If you’ve never heard of “Technical Virginity” – its where you abstain from penile-vaginal intercourse while engaging in everything else. For some reason. Morality probably. It ensures that when they hold your sheets up Day One of your honeymoon that the awaiting crowd can be reassured you were a virgin. If you were a women. Because guys can slut it up as much as they want. Cause that doesn’t matter. Duh!

I find the most confusing part about it all this, is the focus around this coveted virginity test (I am aware the sheet showing doesn’t happen now). Does counting your sexual partners in terms of penile-vaginal intercourse really make sense? Aside from the fact that counting sexual partners in some form of chaste morality contest is pretty strange – does it really make sense saying that giving blow-jobs doesn’t count? What is sex? If blowjobs and going doing aren’t sex, then we don’t need to cover them in education after all. Or, maybe our education can get with the program and start focussing less on preventing pregnancy, and more on giving young people information they need. Lets dump our societal baggage and get real.

To be clear – I think if you’ve chosen to safely and consensually enjoy your body and someone else’s – that is awesome! If that is with a heap of people over time – great. Seriously, who cares? If you’ve decided to wait for “The One” to have penile-vaginal sex with – that is really super too! If while waiting, you’ve decided to have oral sex with a heap of people – again – that is great. But can we please move on from defining sex in terms of penile-vaginal intercourse? Can we perhaps even move on from competitions that spring from maintaining “Technical virginity” and gate-keeping morality and get real?

To true Mr Badger

Sex comes in a heap of different sizes, shapes and styles. Its a heap of fun and it is for a lot more than procreation. Young people for ever and a day have been having oral sex and jerking each other off in the back of their cars/wagons/etc. It is all sex. If you’ve been having a really fantastic time with someone and engaging in oral sex (giving and/or receiving) – I don’t know or care if you’re a virgin (and to be honest, no one really knows – or cares – so get over it). But I do know that it is sexual activity. You are or have been sexually active. You have sexed with people/s. Surprise!

Now you’ve gotten over that shock – we need to think about what we can do about all this sex that is going on.

We all need to learn about sex, about being sexually active and about how to negotiate consent. Preferably before we start doing it. We all need to learn how to do it safely and hopefully well, so everyone involved has a good, wholesome, fun ole’ time.

As adults, we need to advocate for real relationships and sexuality education – stuff that will actually help. When it’s needed. Lets get real and give people what they want. Useful information with a lot less slut shaming.

So hard hitting it hurt

Hard-hitting adverts change behaviour. You have to shock people in to altering their behaviour. Just like the Grim Reaper adverts right? Right?

This week the Heart Foundation launched its new ad campaign targeting everyone who has made a poor life choice in a hard-hitting campaign that drilled in on the idea that if you don’t look after your heart health, you are selfish and don’t love your family. Now, that is not my cynical take on this – the ads were incredibly direct, incredibly focussed on the individual and incredibly brutal.

Its is fair to say, the response online was a little less than supportive of this brave campaign move – with people from advertising panning it (especially Dee Madigan – who called it a “monstrosity”), and public health luminaries also questioning the angle. The Heart Foundation doubled down on their content early on and backed it to the hilt – extolling the fact that so many people had gone to the website and there was a “discussion going on” as proof that this campaign had hit the mark.

Brave move *heart emoji*

Now, overnight – no doubt after a few frantic board discussions, the Heart Foundation has walked their decision back and decided to edit part of their advert, deciding to remove the opening scene of the mother tucking her son in and apologised for offending basically everyone. They stand by their stance that if this campaign drives people to have their heart checks than its a job well done. I don’t begrudge them for feeling the need to do something drastic. Something that shakes up the conversation. I’m just not sure this is it..

Did the baby go out with the bath water?

So is there anything wrong with this kind of hard-hitting mass media if it gets results? Well, putting aside from the heartbreaking tweet I saw from a father who was now stressed his eight year old daughter with congenital heart disease might hear this advert and think her disease is because she didn’t love her family enough; and putting aside the thousands of loved ones who are left behind to hear this message after their family has died from heart disease – what’s the problem?

Everyone gets really excited about the Grim Reaper campaign in the 1980’s that saved Australia from the AIDS epidemic. It was ground breaking advert content that changed the direction of modern Australia and saved many deaths – particularly amongst men who have sex with men. Except it didn’t really do it alone. This ad campaign was incredibly memorable. Definitely striking. It did lead to increases in testing – particularly in people who didn’t need to be tested – but what prevented an rapid increase in the spread of AIDS was not this ad. I feel the Heart Foundation response to double down on this campaign lines up with the champions of the Grim Reaper.

The Grim Reaper ad campaign ran for three weeks on TV, had short run in print marketing and was on the radio for a couple of months. Around the same time there was the early implementation of policy for testing of blood donations. Very solid sexual health promotion work particularly focussing on condom usage. The increase of needle exchange programs. Attempts to improve sexual health education in schools (still a work in progress). Policy and health promotion programs made a difference. Advocacy and interventions made a difference. The Grim Reaper gets the credit.

Surely that is ok though – the work got done. Who cares who gets the credit. Well – some people do. Like the community that the Grim Reaper ad campaign was supposed to help – the men who have sex with men. Who reported significant issues and ongoing negative impacts from this campaign – that continue on.

Mass media health campaigns that focus on fear, stigmatisation and shame are really popular and have been since the 1940s (when the original Grim Reaper campaign ran preventing road trauma – told you it wasn’t ground breaking). Politicians love it – Kevin Rudd’s launch of his government’s “Don’t turn a night out into a Nightmare” Binge Drinking Campaign in 2008 was heavy on negative messaging, fear-based content and targeted a group of young people who thought they were “bullet-proof”. It even had a video game. Neato. Campaigns before and since on everything from road trauma to obesity to smoking to methamphetamines take the same route. This are ongoing questions over the efficacy in actually changing behaviour (Soames Job 1988, DeJong 2002, Stylianou 2010) and while there is evidence and support of its efficacy (Fairchild, Bayer et al. 2018)- employing fear harnesses stigma and must be done with great care

What do you want – love and rainbows?

I know how much people love punchy, scary ad campaigns to “scare ’em straight” – but can we just try and be a little more inventive? I know that is hard when a Minister wants something punchy that “will make a difference” – so advocacy and education is needed.

I’d personally love to see more campaigns that actually addressed some of the Social Determinants of Health and swam a little upstream from blaming individuals and creating stigma and shame. (Tell him his dreaming).

I’d really love to see some that consider the Ottawa Charter for Health Promotion when they are developing a campaign. I’d really love to stop seeing marketing that focuses so purely on the negative and is aspirational and inspirational – that connects with us more at a intellectual levels than through primal fear. That enables us. That creates a supportive environment for change. That strengthens our community – rather than telling people who have had heart conditions they don’t care about anyone else. Would it kill everyone to use some humour for a change?

I’ll leave you with my favourite Grim Reaper advert – and perhaps my favourite injury prevention advert ever. It deserves to be a template of thinking out side the box, but it doesn’t tick enough fear boxes. Social Death is a real winner in my eyes as it taps in to something other than brutal fear of death. Its a little aspirational. A little bit call to action. A little bit funny.

DeJong, W. (2002). “The role of mass media campaigns in reducing high-risk drinking among college students.” Journal of Studies on Alcohol, Supplement(s14): 182-192.

Soames Job, R. F. (1988). “Effective and ineffective use of fear in health promotion campaigns.” American journal of public health 78(2): 163-167.

Stylianou, M. (2010). “The Return of the Grim Reaper.” History Australia 7(1): 10.11-10.18.

Fairchild, A. L., R. Bayer, S. H. Green, J. Colgrove, E. Kilgore, M. Sweeney and J. K. Varma (2018). “The Two Faces of Fear: A History of Hard-Hitting Public Health Campaigns Against Tobacco and AIDS.” American Journal of Public Health 108(9): 1180-1186.