Down and dirty in Lancefield – SexRurality 2017

This August I was lucky enough to pack my bags and head across the land to rural Victoria. Lancefield to be exact. I was heading to SexRurality 2017, a small but vibrant conference put on by the University of Melbourne’s Centre for Excellence in Rural Sexual Health. As a rural-based PhD candidate, researching how to improve the coordination of sexual health interventions in small rural towns – I’d struggle to find a more relevant conference.

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I arrived in Victoria tired, excited and unsure what to make of this conference. I’d followed the 2015 instalment via Twitter and had liked what I had seen. This conference is primarily pitched at workers, researchers and educators in rural Victoria – I was unsure how relevant I would be to them, and what would be made of my presentation. Getting away to Lancefield was the culmination of an absolutely desperate couple of weeks – busy family life, hectic work and a few curve-balls thrown in along the way. Funding my trip was a stressful challenge – as a PhD student that has the privilege of undertaking my research sans scholarship (APA or otherwise), I found myself in the position that my School would fund my trip – provided I was presenting. Except abstract acceptance took a little while. They would also fund certain things upfront, others I would need to claim reimbursement. After a fragile few weeks that bordered on financial ruin, my abstracts were accepted, money flowed where it needed and I was buckling my seatbelt and stowing my hand luggage.DGGWWBJV0AADfXU

Lancefield seemed nice. Nestled near the Macedon Ranges, it is a tiny country town, with a quiet main street. I wandered around the afternoon before the conference trying to get a feel for the place. It was so close to Melbourne (75kms), but felt so far at the same time. It was, thankfully close enough that coffee in the local cafe was good and cheap! SexRurality was being held at a winery conference venue. It was going to be a tough few days.

Our conference kicked off as any should – with a heartfelt, informative and challenging Welcome to Country. Given how we came to be in possession of this land, I have no problem when a Welcome to Country touches on the removal of land and property and makes you uncomfortable. How can we understand where we are going, if we cannot acknowledge the past? Perry Wandin delivered this Welcome to Country. We were meeting on Wurundjeri land – and from what I had seen of it so far, it was beautiful. Perry gave us a bit of history of the area, told us about the Healesville mission, about Coranderrk, its granting to the Wurundjeri people and its removal when local farmers decided the land was too profitable to be in the hands of Aboriginals. Perry’s delivery was relaxed, passionate and informed. He gave me a glimpse of what had come before us in the area, and a hope of what could come.

We had a solid opening session. Professor Bill Adam welcomed us to the conference and touched on the need to train rural health workers in the rural setting. In order to get people in to the country, you need to train them – but you can’t just drop them there as juniors or students and hope for the best. There must be training for the trainers. Centralisation of training not just an issue for rural Victoria – it is incredibly challenging to do post-graduate or doctoral study in rural WA.

MP, Mary-Anne Thomas delivered a welcome address and launched the CERSH online modules on Rural Sexual Health Care. Thomas is the Labor Member for Macedon – and I have to admit, gave an impressive address. I’ve seen many an MP “phone-in” conference addresses. There was, of course, a nod towards the work her Government was doing, but what I appreciated was the sincere engagement with the topic and the context – Thomas spoke like someone who understood rural sexual health, not just read a briefing note. Thomas encouraged everyone present to “keep making waves and ripples”. This I appreciated.

 

Louise Galloway spoke on strategy developments to address stigma and discrimination as part of State wide policy in Blood borne virus and sexually transmitted infection control. Galloway asked us – what target is acceptable for stigma and discrimination? Her team were trying to set an appropriate target and agreed, you must set a target of zero. Associate Professor Jane Tomnay, gave us an overview of the work that CERSH was undertaking – and highlighted that there was not a single piece of work that CERSH did on its own. Tomnay noted that a lack of specialisation is a key characteristic of workers in rural areas who address sexual health. This is a key component of my own research – it’s no ones job. While this is an issue, there will be no improvement in specialisation any time soon, so we have to find ways to harness this generalist approach and find intersections in roles and improve collaboration. Professor Chris Fairly rounded out the morning session giving a clear and interesting presentation on the importance of government policy in addressing sexual health; how policy is more important that individual choice in this area.

After the break, we heard from Deakin University researchers and peer educators on the Sexual Lives and Respectful Relationships project – a program focussed on intellectual disability and sexuality. We were asked if supporting people with intellectual disability part if your core business – and it was highlighted within the presentation that accessibility takes more than a ramp, but a whole system approach. The SL&RR project peer educators gave us an insight in to what the project was really about and the type of content that was delivered. The program isn’t about teaching slang for body part and sex, about setting the rules on who you can hug and how, or about condom use. Its focuses on conversations, facilitation and community connections.

Our next presenter was author, Clementine Ford. Now, Clementine is known by everyone to be a man hating femi-nazi that won’t rest until women are all that is left of the human race. She makes grown men cry on the interwebs; says really mean things; and spews streams of misandry laced with vitriol. This is according to the bands of MRAs on Twitter (they even sent ME a few tweets once they knew I was sharing a presentation room with her). I’m a big fan of Ford. Her book is excellent, challenging; uncomfortable reading – and I was nervously excited by what would have to say.

flagFord talked about many things. Reproductive rights were a key theme; reproductive labour and child rearing responsibilities; how women die from abortion when it is unsafe; that access to abortion is a fundamental right. Ford urged us to change the conversation and perception of who actually accesses abortion; and to stop fighting the pro-life movement using pro-life language. Ford spoke about how abortion is not a first line choice for contraception for people – but it should not be excluded from the conversation when we plan and talk about it.

The question time for both presentations was intense. It was interesting. It was challenging. And after everything that was discussed, I felt like I’d learnt many things. One of them was how poor post-partum health care is and how much better it needs to be. There was a lot of passion in the room about the pelvic floor and its recovery. I felt schooled. kegel-chat

The afternoon sessions were split streams. I missed a significant chunk of time from one session, having a great conversation with Ford in the dining room. I wasn’t kidding about being a fan, and the opportunity to have a conversation with an author I respect was not something I could miss (and an embarrassing request to sign her book). Ford was incredibly generous with her time, given the juggling of responsibilities and engagements, and I’m really grateful of the time she gave me. We talked about men, about empathy, about dance, about a few things really – and I have to say, its surprising (not surprising) how wrong MRAs (and a fair chunk of Twitter) are about Ford (given their views on feminism, maybe not a shock). Despite all the Twitter warnings that I would be dismembered or beheaded; I was left with a great appreciation of a hard-working author, a list of books and papers to Google, and a signed copy of Fight Like a Girl. I know right, who’d have thought.

I rejoined the conference and jumped in to learning about how people were improving sexual health through social media and digital technology. Anna Roberts gave us a run down how Gippsland Women’s Health had used their #areyoucovered campaign to let young people in their region know where to get their paws on contraception from condom vending machines. They even had local governments competing against each other to see who could move the most “units”. Way to go harnessing those small town rivalries. I say we do the same. I’m looking at you Mt Barker.

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Linette Etheredge explained her PhD project engaging young people on intimate relationships through digital technology. One of the things that stuck with me from this presentation was, aside from the content; it is so hard to explore what young people think about sex, sexuality and relationships when we can’t get ethics to study them. This group need protection from exploitation, but given how many young people are sexually active at an age younger than what we can feasible get ethics to ask them about it – how do we support them? Megan Lim from the Burnet Institute, delivered findings from their online survey on young people’s perceptions on the impact of online pornography. It was noted that watching pornography online was common and frequent in both genders – with both genders noting problematic use.

The afternoon was a fantastic panel discussion on diversity, equity, rural life and sexual health. From the provision of care to refugee women living with HIV in the rural setting, to dealing with female genital mutilation, to improving how we address sex, pleasure and diversity, to addressing the needs of queer youth, to using a consortium model to improve sexual health outcomes for young people. There were simple solutions to complex challenges – things as pure as being respectful and watching your language; finding solutions to clinic booking systems, from being flexible with bookings to code-words to improve confidentiality; to just being flexible in general. Franklin John-Leader gave a key quote for me in the context of finding solutions in your region- in that “you can’t wait for people with magic bullets”. My entire PhD project was started on that idea – there wasn’t anyone else coming to do this.

It was a huge first day. I was pretty nervous about day two – and my chance to speak. I was tired from hearing from such fantastic presenters. We headed off for the usual canapes, drinks and dinner. This was a sexual health conference, not a nutrition conference, so the food wasn’t too healthy, there was cheese and cured meat and fantastic local wine. Don’t judge me. I was self-determinating. We also had great entertainment from the very talented Benny Walker. Playing to a room full of networking delegates is tough, but this guy was great.

Day two kicked off hard and fast. Marilyn Beaumont, OAM and Buga Up Alumni, got us rolling with a stirring and powerful reminder of the importance of advocacy in women’s health. Beaumont gave us the history of improving access to abortion in Victoria and the incredible amount of sacrifice and effort that their group went to. There was a standing ovation. It was deserved. To hear from this person, and the amazing work she and her colleagues did to advance human rights in Victoria (and Australia) was humbling, inspiring and a privilege.

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Dr Paddy Moore followed to give the current context of abortion service provision and access in rural Victoria. Circa 2013, the single most common reason for women to travel to Royal Women’s Hospital was to access abortion with many women travelling from across rural Victoria to access abortion services at this central. Moore spoke of the need to continue to improve rural access to services – in town, not in the city; and how they had gone about doing this. Dr Alan Hulme Chambers followed, to explain systems, statistics and stories of medical termination of pregnancy – and highlighted the need to maintain advocacy alongside service and system development. Hulme spoke of the importance of building local networks and ties for improving on the ground intelligence; and trust. These things were critical in delivering services in rural area. All spoke of the complications of providing abortion services in rural towns with abortion provider stigma and community politic – and how despite overwhelming public support of medical termination, health services still don’t advertise due to fear of backlash.

The late morning session was sexual health research in rural communities. I was up. I tried my best to focus on my fellow presenters and tried my hardest not to break in to a large sweat. There was a presentation giving a comparison between metro and regional medical and nursing care; Stephanie Atchison stepped out of her lab to present on the (lack) of knowledge HPV in Australian Men; Emily Grant told us about her roving exploration of the Barwon South West region in search of condoms (to assess for young people’s access). Vendors hiding condoms above the cigarettes to stop them being stolen, condom vending machines in weird places and a general lack of access were the key themes.

Shannon Hill presented on the referral pathways and practices in rural Victoria – with a lack of clear pathways, confusions and inconsistent knowledge common. Next up, was me. It was a kind crowd and there were mainly positive reviews. A big thank you to Siobhan Bourke for snapping me, and thanks to everyone that didn’t leave. Declan McGavin rounded of the session with his presentation on practice nurse and practice manager perspectives on sexual health discussions with older Australians. We can’t forget “older” Australian’s are having sex. As one of my nursing lecturers once said to me – when would you like to stop, pick an age.

Lunch was eaten with the appetite of a man relieved to no longer have to present – a tired content that bordered on an inability to re-engage with the conference at all. If you’ve presented, you know what I mean – it’s not that you don’t WANT to get back in to it, it is just that the pressure is off, you can relax, and a nap would be amazing. I held off on the nap, ponied up and went back for more.

Jack Nelson, from CERSH, spoke about their SHOUT project. One of the things that really stuck in my mind about this presentation was the analysis of previous poster campaigns by young people. The language on the posters didn’t match with the young people’s own language – it was trying to be cool. That was lost on them. Anna Roberts doubled up to talk about trying to get schools to engage in collaboration to deliver relationships and sexuality education. Results hadn’t been amazing – and goes to show, even with incentives, sexual health can be a hard sell. It was also great to hear about things that weren’t working so well – we can learn from struggles as much as success. Eileen Berry, professional journalist come sexual health resource creator presented/was interviewed about developing her parent guides resource. As well as giving us a great insight into what is basically a passion project (of wonderful merit) and how it came to be, Eileen also gave us some great tips on dealing with the media, the best being:

“There is no such thing as a free lunch, if you’ve got a lot of secrets – don’t go lunch”.

We wrapped the conference with a review of all the sessions – there was so much great content. Then wearily, everyone headed off, back to reality. Back to places where sexual health is nobody’s job; where no one is that interested in young people getting condoms; where abortion is judged through a moral lens; were the world is binary and there is much contradiction. We’ll go back to worlds where people will want to argue the definition of rural. Where people will say, yes, ok, sounds important, but what about the ice problem? Where feminism is a dirty word.

I was going back to WA. Back to my little office. Back alone, muddling through a project that at times seems obvious and unwanted. At least we know, come 2019, somewhere in rural Victoria, we might all come back together again, to be around friends, to search for solutions, collaborations and ways to make sure sexual health is on the agenda. In the meantime, I’ll be here:

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Young Crew and Severe Injury

I have spent some time working with young people on a program attempting to engage them on the concept of choices and consequences, particularly around partying and road safety. It was hard work. It was enjoyable work. Most importantly, it was work that allowed me to hang out with young people and hope that they cared about what I had to say. It sometimes felt a lot like high school.

When you’re in high school you are desperate for people to like you. To talk to you. To think that you are worthy of their attention and they you have something interesting and useful to say. There is so much at stake. What if they hate me? What if what I say sucks? My work allowed me to return to those anxieties, but at seemingly much higher stakes. I wasn’t just hanging out at lunchtime with young crew, I was trying to convince them that keeping their limbs on was worth their attention.

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Until recently I worked on a project that involved coordinating and delivering a program that focused on reducing youth trauma – particularly trauma resulting from drinking or high risk behaviour. I was basically trying to teach teenagers how to not be stupid. And really, the focus is predominately on young men not being stupid. In 2016, a staggering 71% of trauma patients through the major trauma centre in WA (15-24 year old age bracket) were young men. And primarily young men that had taken stupid, high risk choices. From my home region – young people accounted for 25% of people killed or seriously injured on our local roads between 2004 and 2013. The excuses of the excesses of youth, the difficulties in delivering programmes or vagrancies of funding can’t be excuses for not trying to educate this group.

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I was involved in a really fun program to deliver. I am also the first person to admit it wasn’t always perfect. It could always have been improved, expanded, built upon. Health promotion is most effective when delivered as part of a structured program that is embedded in to multiple areas; rather than one-off field trips – but when you only have the capacity to deliver the one-offs, you have to decide whether one-off interventions are better than no interventions. We endeavoured to ensure the program was delivered in conjunction with other projects and programs, but occasionally it was purely stand-alone. I know what the research says, but sometimes you can only do what you can do.

A major challenge involved in running a project like this, was stakeholder management. So many stakeholders, all very important to the project, all with different needs, goals and motivations for their involvement. There were tense moments during development and delivery that would have been easier to manage with less people to worry about, but that may have reduced the efficacy of the program or the internal and external support. It was a delicate balancing game.

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After navigating the stress of just getting the project up and running – my main joy was delivering the actual program days. Delivering programs to young people takes a significant amount of energy. You have to just go for it and second best will not do. Program days would first involve juggling presenters and pretending on top of everything; then once that was under control the real fun would begin. It would be my turn to hurtle head first in to an awaiting pack of rabid youths, desperate to make my mark, or at the very least, a smeary smudge against the windshield of their youthful egos.

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That is where when head back to high school. Now, this was not peer-education. I’m old. Like grey hair, married with children old. I am so not lit. Sure, I’ve met young people and some of them have even spoken to me in a consensual two way conversation – but I am O. L. D. The young crew I was speaking to were generally in the sticky, messy part of the teenage dream, where parties, booze, sex and risk taking come crashing together with awkwardness, naivety and acne. I’m old enough (if I’d made some dramatic life choices) to be their dad. Or at least their uncle. In fact, for one of the kids – I was their uncle. Now, that was a tough day of trying to balance role duality. The challenges of working in regional areas.

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So, how do you make yourself relevant when speaking to young people without making yourself a grade-A example of an epic toolie? The first step is to sincerely acknowledge that you are not their peer, you are old and you do not know what they are going through. Aside from the fact that this is 90% the truth, it helps establish that you aren’t trying to be cool – you’re trying to be useful.

One thing that was VERY successful for me and a I recommend to anyone working with young people: don’t be afraid to ridicule yourself. It helps reduce the feeling that you are holier than thou and preaching to the group. I never felt that I lost standing mixing strong messages with some self targeted ribbing. One of the most talked about slides from my presentations has been my then and now picture. I use it to introduce the concept of choices and consequences to the program – mainly my poor choices in hair style and fashion.

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Another tip: find a concept and deliver it well. We worked hard on the choices and consequences concept – reduce your risks, help your mates, beware the ripple effect. Trying to convince a group of young people that a potentially silly error could lead to ongoing and possibly lifelong effects is a tough sell – one that can be achieved through making what you are talking about real, relatable and raw. A participant has to be able to put themselves or someone they know in the picture.

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The ripple effect was one of the key tenements of the program. It sprung in to existence from almost nowhere one day and became a core principle of explaining the concept of road trauma to young people. We don’t give young people much credit – they can be portrayed as lazy and self-absorbed. An unfair generalisation that doesn’t allow for the fact that there is great compassion and empathy in amongst our young crew. I would often explain the concept that health workers – the paramedics, doctors and nurses that dealt with front-line trauma are not robots. They are people, with families, and friends and lives that went on beyond delivering emergency health care. The concept that their decisions may actually impact on me and my children’s lives proved to be surprisingly effective in gaining their attention.

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Another pointer: tell real stories. Scenarios are great. Real life is even better. I have, unfortunately, lost far too many friends and peers through road accidents. Some were drinking driving. Some were speeding. Some remain unexplained, many, many years later. All were young men. All were tragedies. All ripped the heart and soul out of families, communities, sporting groups. There is nothing like the jarring finality of the loss of a young life through road trauma. There is a jarring reality when you stand in front of a group of young people and speak candidly about how hard it can be to see the mother of a dead friend, even years later. Explain the times you catch yourself day dreaming about the possible children a mate could have had, what type of dad he may have been, what type of partner. Retelling the reality of a life lost aids with cut-through.

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There was great opportunities to learn from the groups. Not just from what they were saying, but their actions, their responses, their feedback. There is something really exposing about presenting to young people (if you care). You are putting yourself out there – and they will provide direct and cutting feedback if what you are serving up isn’t to standard. The groups I spoke to had no qualms in questioning what was presented, how it was presented. They were fair but harsh critics – and they demand the best of you as a presenter.

The content we delivered was hard going and the manner it was interactive, challenging and occasionally fun. There can be a misconception that if you are learning about a serious topic you can’t enjoy yourself. It is widely accepted that children learn best through play. Surely adults and young adults are the same. This week I was reading an article by Dorothy Lucardie, who highlights that having fun and experiencing enjoyment were recognised by adult learners and teachers as a significant motivators to attendance and learning the knowledge and skills; while fun and enjoyment were considered a mechanism that encouraged concentration by learners and helped in the absorption of learning. We shouldn’t be afraid of making learning about serious topics fun. Why not engage a group, have them invested and involved when talking about the challenges of managing a trauma patient?

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The element of fun, some self-depreciation and relatability and acknowledging that while I definitely wasn’t a peer, I was at least worth listening to – meant that I had a lot of fun delivering this program and excellent feedback from my harsh, teen critics. Delivering alongside some exceptional presenters made my job that little bit easier, and definitely ensured that we had maximum impact on participants. This project was heavily evaluated, and the feedback forms were always glowing – but the biggest things that I would take from delivering the program were the unexpected outcomes, the remembrances, and the relationships with my fellow presenters.

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The value in presenting that program was always the things on top of the content. The outcomes no-one knew would exist. Two male students chose to study nursing after attending the project, changing their study preferences in perhaps the biggest professional compliment I have ever received. One student spent the day seemingly ignoring the key points of the program, before everything clicked in the final 15 minutes of the day. He solemnly shook my hand at the end of the day, staying back explicitly to do so – and still welcomes me in the street 2 years after he attended the program. The young people who remind me they were participants as they serve me coffee in local cafes, thanking me for the program. The parents who approach me and tell me their child raved about the program at home and that they hope it continues. Those were the things that made it really worthwhile, and are the things that cannot be captured on an evaluation or wider expansion of a program. The intangibles, the connections you make, the moments of realisation in a participant’s eyes. You can’t capture that – but it makes it worth throwing so much of yourself in to it.