Peter Strange presentation

Peter Strange presentation at the Department of Health “Engaging men in healthcare seminar”

23 June 2011, 50 Lonsdale Street Melbourne.

START OF TRANSCRIPT

I guess what I want to talk about today is a model of practice that we started in Bendigo ten years ago. I came from CAS, critical care. I went into community health and they - I sort of sat there for two weeks and they said you’ve got to do some men’s health stuff and I knew nothing. So we went out to the community, we asked the guys, we did evaluations, and we’ve been I think operating a successful model of practice for ten years now. I also believe as we go through this model that you’ll see that this model can be adapted. It’s very simple but it can be adapted for all different communities and some variations will sort of work with that.

So engaging men is the first step towards better health outcomes. I think that’s what we’re here for today. That’s the toughest part of men’s health as I see it - actually engaging men. It certainly is in regional Victoria. I often get asked by other health professionals - we can get the women out, we can put on events, we can do this, we can get them to the doctor or they go automatically. How do we get the guys to do that before they reach a critical state? Before they hit CAS (critical care) with a heart attack or with a stroke. I think that’s really important. We’ve tried to put some emphasis on that and we’ve tried to design our program around engaging men in Bendigo.

So this guy’s got it pretty easy. What you’ve got to look at - even though this is obviously a bit of fun here but what we’ve got to look at is how do we engage these guys? We want to get to these guys. We want these people to turn up and we want to try and change their health a bit. We’ve got to educate these guys and there’s often stacks of guys like this that will say why would I want to go and see a doctor when I’m perfectly healthy? Am I unhealthy? Or for what reason? So you have to start from the basics.

Education is obviously important to convince people like this that they do need to change, otherwise they’re going to be a significant statistic. So it’s difficult to do that. Unless we want to work with the worried well where we can certainly get our stats up and get thousands of guys out - we can still do that - we need to have different approaches in different communities.

Andre is a friend of mine. He’s a guy who lives in Bendigo. He’s a professional guy - what I sort of call typical. I’ve known him for quite some time and he came along to one of my talks and I was talking about preventative health and cholesterol and glucose and this and heart attack and the usual sort of things like that. He sort of went home and he got a little bit inspired and he jumped on the scales. He was five foot eight. He went over the top when he found he was over 100 kilos and that sort of worried him a bit. He thought oh I think I’ll go and see Peter and go to his clinic and find out what’s going on.

We did some numbers - cholesterol, glucose, those sorts of things - and his numbers were up slightly. So he took that into account. He said what do I do? A very intelligent man. He was the guy that’s got four kids, busy at work, basketball coach, on school councils, didn’t have time off and sort of going around the stadium with chips and gravy. Never had time for himself. So he changed all that. He started to eat healthy and he did a little bit of exercise. Lost 22 kilograms. All his numbers turned to normal again.

I asked him in an interview we put in the paper - I said what was the most important thing that changed - he’s five or six years down the line now and he hasn’t changed. He’s still fit and doing his exercises. So I asked him what was the thing that changed? He thought for a little while and he said hmm I gave myself an hour a day for myself and for nobody else. Not for the kids, not for work, and that for him was between five and six o’clock at night. He said I might jump on the bike, I might go for a walk, I might go for a swim, sometimes I might even just sit on the couch, but he gave himself some time for his own health and I think that’s what we’ve got to educate men to do.

This is sort of what I do at the clinic - men’s health clinic that I run. This is like an annual check up - as you’ll see - modifiable risk factors and unmodifiable risk factors, so there’s a lot that we can do. We can educate men and we can get them involved in their own sort of health. The model of practice - pretty simple. I don’t see any need to change it and I do think this model can work in all sort of different communities. So in the middle of Melbourne or right out in the sticks if you vary it slightly this will sort of work. Health promotion at the top - what I call a splash of colour. That creates some energy in a community.

Then once you’ve created some energy in the community then we have to look at providing a service, which is like a men’s health clinic and that’s the mistake we made when we started it off. So we went out and we engaged. We wrote 82 letters. We engaged with a whole load of different communities, Lions, Rotary, the university, the local council, got all these people out to this men’s health night and then we thought oh crikey, the doctors are in short supply. We haven’t got anywhere for them to go to. They were saying I want a health check up but we couldn’t get it. So we sort of reversed it. We made that mistake and then we developed a friendly - male-friendly men’s health clinic now and we also educate doctors and Greg certainly helps with that. It’s more male friendly, so it works. Then we also realised and also what Greg was talking about is that men won’t come in the door quite often, so we have to go out to them, One of the favourite places to go is to go to their workplaces to make that succeed.

So men’s health promotion. The one at the top of the triangle first. This is what we sort of do. We have a men’s health week in September, still probably the only one in Australia but we get thousands of men out in Bendigo and that’s probably what we’re a little bit famous for. A walk around our local lake, the boardwalk, boardwalk restaurant. We get 180 guys out at 6:30 in the morning walk around the lake, give them a feed, have a bit of a chat. Then in half an hour redo that and get another 180 guys out and give them a feed and a bit of a chat. Then they can go to work. They walk around. We get celebrities down like Andrew Gaze and we get people to sponsor it and all that sort of thing. This is it.

This lady with this restaurant provides it to us for nothing and the staff. She’s really interested in men’s health so she puts that on. She said well we don’t have anyone in the restaurant at 6:30 in the morning so may as well use my staff and away we go. That’s the sort of thing that you can do if you go out there and run these programs that can be successful. You’ll see the mix of guys. It’s quite successful because it’s a half-hour talk so the guys can go to work afterwards. So they can come in - they come in their suits and you’ll see them in their suits and you’ll also see them in their tracksuits and a mixture of a whole lot of different guys that have to get off and whatever. So it’s a very successful way of doing it and it sort of really works. We might deliver one or two health messages and somewhere for them to go over a short period of time. Very short and sharp, which fits in with guys and it’s good marketing sort of process.

You know things to do during men’s health week. We dress men up in LYCRA. This is an invitation - Bendigo is really terrific as far as bike riding is concerned. Started off with two guys going to a coffee shop and having a Saturday morning ride. They’ve now got 400 guys riding around Bendigo and you have to leave at all sorts of five minutes intervals with groups of guys doing that and they all still end up back at the coffee shop. So it’s really good. They have a chat, they socialise - which is important for men’s health - and they have that little bit of competitive approach in seeing how good they compare themselves in LYCRA and who looks the best.

This is what we run during men’s health. We have an introduction. We get some of those guys that are experienced riders and the other guys can come along without the LYCRA on and the gym boots and the old bike and they can start off and we all go slow and then that gets them into the group. We can also talk to these men about health as well. Anything that we can do to make the guys happy and get together.

We have Merv (Merv Hughes cricket celebrity) down and he comes down and he talked at one of our breakfasts and packed the place out and took them for a walk around the lake and of course had a bit of fun with them on the lake. You see the smiles in the background of these guys. Have you ever seen a bunch of guys closer together and they are ready to receive the health message when they come back - particularly with a full stomach.

Andrew Gaze - we took him around - we took him around all the schools and packed all the schools - utilized him one year and that was also talk about men’s health - we always forget to talk about young men’s health and you’ll notice that in front here is a young woman but that doesn’t matter because men’s health it’s also really important that we talk about women’s health as well. Amazingly enough this shot is quite incredible so at the end of his little talk he did pick someone out, which was this young girl, three three-point shots with Andrew Gaze. She had him two-all. First time I think anyone’s ever seen Andrew sweating. Mind you he made the third and she missed it so he’s still able to do that.

That’s health promotion. That’s what we do in Bendigo There’s a vast amount more about it. The second point we go out to the workplace. It’s really important. Men’s work is vital to them. It’s an important part. So we can go out and introduce health into the workplace and if we can talk the employers into it and convince them that it’s good for them to have healthy workers and have 30 minutes off for a health assessment or if we can just go and talk to them or use that it’s really important.

We can pick particular industries whether it be meat works or whether it be industrial areas or we go to a bank or to schools and see teachers, we can actually pick and you can actually find out what they require. We often find out high stress areas amongst teachers and you find a different situation out in the country amongst farmers. So using industry, using workplaces, and getting off our buts as I believe nurses and nurse practitioners can and going out to the men in their environment. Greg talked about how important that was. Rather than waiting for them, put up a little sign, you come in here and have your annual check up - not very likely often.

This is one of the workplaces that we go out and see - Bendigo Saleyards. So how do we go out and run this? These are the bunch of guys. Often the farmers are quite physically fit but they have some lovely food out there, there’s a lot of animal fat in it, and they have a high cholesterol level often.

So we go out and we engage with these guys. We walked amongst the sheep poo. We get out there early in the morning. We go and see these guys. Will you come and have a bit of a check up? Oh mate I’ve got to sell 50 sheep, I’ve got to sell 500 sheep. What time are you selling them at? 10:30 in the morning. Okay well what about 11:00? Have you got a bit of time then? Oh yeah I’ll be able to fit it in. We do the health assessment out at the saleyards. We give them a little ticket and they come by and they do a health assessment. Lo and behold we find a lot. We introduce them. We get them into their doctors and they start to see the benefits.

We talk to the kiosk here you know when we went out there and it was all fried fast food. So 6:30 in the morning they’d been up since four or five o’clock in the morning, it was the bacon and the eggs and the fried whatevers. We changed and we introduced sandwich and lo and behold they actually like sandwiches. So the barriers. We went around some of these industries and I asked the guys. We put on some health session and I went to the guys afterwards, so 50 per cent turned up even though they had half an hour off and 50 per cent didn’t turn up. I went back out on the floor and I asked why didn’t you turn up? They sort of told me quite honestly what was the reason. Barriers were you know including in rural areas isolation - with the farmers, self-employment. Will I get off a tractor to give one hour per year to a doctor? We have to convince them that or we have to go out to them to those sorts of areas.

The importance of work - there were guys that would not stop their machine to go and have a health assessment even though the employer had organised for someone else to take part - it was his machine and I was going to work it and that was how important work was to him. He didn’t think that he could be disposable I guess.

Confidentiality was really important. They were worried about information getting back to the employer. A reduction of consultation time is something that’s also a great barrier. When I talk about the clinic that’s the number one thing I find. Guys do want to talk and will talk if you give them and you ask them questions and you give them time to talk. So consultation time there’s a really big barrier. I always think we actually do them a disservice, particularly men, if we give them a five minute consultation. I know that’s very hard to lengthen those times but it’s really, really important. This is what I’m hearing from the guys directly sitting down with me sort of saying this is why I’ve changed, this is what you know he sort of looked at his watch and he pushed me out the door. They won’t go back even if they’re unwell. It’s really important.

Fear of the unexpected. What’s going to happen in that little room with Peter Strange? So we have to talk about the beforehand so they are - they’re big tough men but they really are scared about what’s going to happen, what’s going to be asked, so we need to make that clear and simple. Poor communication between health professionals I believe and between men. We must talk about preventative health practices. Prevention, prevention, prevention, because the guys often don’t get that. Why would I want to go and see a doctor when I’m perfectly well. Are you perfectly well? Will you have symptoms? If you’ve got high cholesterol, mildly high diabetes, high blood pressure, no you won’t have any symptoms. Are you likely to be a statistic with cardiovascular disease? Yes. We must educate and get that mindset changed.

Men in Sheds. Greg talked about those - fantastic. There’s 400-odd throughout Australia now. There is no better place to have a chat to a group of guys. We’ve got three Men in Sheds with just one more starting off in Bendigo now and they’re all over the place. They come in their overalls, they’re happy, they’re working. We go in and we deliver a health message and I often ask them what they want to talk about. It’s usually someone’s just been diagnosed with bowel cancer, so the topic for the day will be bowel cancer within the shed. Then they ask the questions. So these 20 minute chats that we have often got into two hours because they engage me to keep on answering the questions so they’re great places to talk about health.

The men’s health clinic - really important. We developed a male-friendly men’s health clinic, which I run of a Tuesday and sometimes a Wednesday evening. Thirty to 45 minute consultations is the most important thing. We may not be able to do that with doctors but we can do that with a partnership of doctors and nurses because they can do a lot of preliminary - like Greg said - and doing that is really important.

These guys will talk if you ask them the questions. They will not talk about their mental health unless you ask how are you going, mate? How’s your mental health? They will not talk about sexual health questions unless you ask them. Every guy that comes through of the right age I ask do you have any problems having an erection. These guys will travel for sometimes hours and hours and hours. If you don’t ask that question they will go back again and they won’t bring the topic up. We need to ask the question. We need - if we do ask the questions we need to give them time to have a discussion and answer, so longer consultations and guys will chat.

Waiting times are really important. We run an evening clinical - Greg does - so that guys at work can get there. So start at sort of half past two and go through to nine o’clock at night. GP referrals on the spot if we can and annual reminders are terrific so we send them out an electronic reminder. Men are interested in their own health, they really are, and men will engage in positive health practices if they are encouraged to do so - that’s our job - and they are in an environment which supports positive health practices. That’s also our job and I think the job of DHS as well.

The very last little thing here is another face. This lady is a very intelligent lady who lives about 50 km out of Bendigo. Her name is Sheila. She rang me up one day in tears. She said I’ve lost my soul mate, I’ve lost my husband. She’d been grieving for a year. She was out on the farm. She said we’ve got to do something about this you know my husband wouldn’t go into the doctors, he wouldn’t be interested in preventative health, he contracted diabetes, he had all sorts of chest pain and it was sort of too late for him. She lost the soul mate and she was still crying about that a year ago.

She rang up quite angry - and this is an intelligent lady. She said I’ve written a letter to the Minister of Health, the Federal Minister, demanding that every man aged 50 should have a compulsory men’s health check. I said that’s a nice idea; I don’t know whether that’s possible making it mandatory. She said I haven’t finished there. She said I feel that they should be fined $1000 if they haven’t. I’m not sure you’ll get that through. But this is a really intelligent lady and I still see her around.

This is what it’s about because men’s health is also about women’s health and often it’s the women that get the guys to come to the clinic. They often arrive at my place with a little what are you here for you, mate? Out comes the top pocket a little list; this is evidently what I’ve got to see you about and Pete I wouldn’t mind a bit of documentation to show that I’ve actually been here. That would be really good. So women are important for part of men’s health and it may be said they provide balance in our lives. Thank you very much.