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Multicultural Council of Tasmania

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					  Multicultural Council of Tasmania




  Continence - Questions You Have,
 Answers You Need, Support You Gain
    Towards a Model for Meeting the Incontinence Health Needs of Older
    Tasmanians from Linguistically and Culturally Diverse Backgrounds




                        Final Report



Sajini Sumar, March 2002




                                                                         1
Our thanks to:
Commonwealth Department of Health and Aged Care, for funding the project

McoT Incontinence Project Manager,
Sujini Sumar - for the many voluntary hours she committed to this project

The Multicultural Council Incontinence Project Steering Committee
Eric Madsen
Alex Dzienzil
Sajini Sumar
Rohan Wirasinha
-for project guidance and financial management

Incontinence Advisory Uni, Department of Health and Human Services
Deborah Traill, Incontinence Nurse Adviser (South)
Pat Maddox, Incontinence Nurse Advisor (North and North West)
-for feedback on target groups, program content etc

University of Western Sydney
Greta Mason, External Evaluator
- for continual project review, and on-going suggestions for change
    -
Women Tasmania
Wanda Buza, Director- for assistance with project design, submission and reports

Good Neighbour Council (Launceston)
Jean Boulis- for helping to contact isolated people

And to the many other community leaders- who assisted McOT in organising the
seminars, and to the participants who came along. Without support of all of these
people such workshops, and information sharing sessions would not have been
possible.

Sajini Sumar wishes to express her thanks to her husband Dr Nazir Sumar and her
children Faisal, Faheem and Salma for their support and encouragement, and in taking
their time to manage this project. Special thanks to Faisal for driving his mum long
distances.




                                                                                   2
FORWARD
We are pleased to present this report which covers a series of workshops targeted at
older men from ethnically and linguistically diverse backgrounds. The workshops
were designed to deal with the issue of Incontinence management and to help provide
information on managing incontinence and where ongoing assistance is available.

People from non-English backgrounds face many barriers in accessing health services
due to language and cultural differences. Much work went into planning these
workshops which were held around Tasmania between July 2001 to January 2002.
Workshops were organised in each of the regions (South, North and North West)
through pre-planning visits and workshops. A number of successful workshops were
also held with specific ethnic groups.

The following report has been compiled by Sajini Sumar, a qualified Nurse with
extensive years of experience overseas and in Australia in working with people from
ethnically and linguistically diverse backgrounds in a range of health care services.
The report provides a useful summary of the workshops and maps a way forward to
organising further sessions. The Multicultural Council would like many more
workshops addressing more health issues for this population group to assist this group
and through prevention reduce the pressure on the hospital system.




Rohan Wirasinha
CHAIR of Multicultural Council of Tasmania




                                                                                    3
Contents
Incontinence in the Community                         5

Background                                            5

Planning Framework for the Project                    5

Population profile                                    6

Workshop program                                      9


        Southern Multicultural Forum (Hobart)        9
        Northern Multicultural Forum (Launceston)    12
        North-West Multicultural Forum (Devonport)   14
        Greek                                        15
        Chinese                                      16
        Italian                                      17
        Croatian                                     18
        Rural and regional-east Coast of Tasmania    19

Observations and Recommendations                      21




                                                          4
Incontinence in the Community
The Multicultural Council believes that many barriers prevent persons from ethnically
and linguistically divers backgrounds from accessing main stream services, and that
these barriers are inclusive of language difficulties (including reading), lack of
confidence and apprehension about public departments, mobility problems and
general social isolation. While continence problems can occur at any stage of life, it
can be especially prevalent among the frail aged. For many older men it is also a
source of deep embarrassment that can severely restrict their capacity to lead a full
life. It can also place an added burden on families and carers at an already difficult
time. Special strategies are need to ensure that older men (many of whom migrated to
Tasmania– that we find a way of providing better support to them and their families.

Background

In 2001 the Multicultural Council of Tasmania applied to the Commonwealth
Department of Health and Aged Services for a grant to develop a model for providing
information on Incontinence Management to older Tasmanians from ethnically and
linguistically diverse backgrounds. The project aimed to target older people
(specifically men from ethnically diverse backgrounds who often do not access
mainstream services.

Project aims included:

      Improved prevention of incontinence problems
      More effective management of incontinence
      Facilitation of links between people and services
      Sharing of support between attendees

The project design was based on:

    a series of regional multicultural workshops
    a number of workshops targeted at particular ethnic population groups
    a small group program for the rural community on the East Coast of Tasmania

As the project evolved some changes were made to the pre-planning phase, publicity,
approach, workshop content etc as a part of the ongoing evaluation and review
process. In this report I have documented the way in which the workshops were
organised, what I learnt along the way, what participants told me etc.


Planning framework for the project

The Multicultural Council established a steering committee for the project ( Eric
Madsen, Alex Dzienzil, Sajini Sumar, Rohan Wirasinha) to manage all aspects of the
project including timelines, reports, financial planning and evaluation. The committee
initially met weekly to monitor the project. As the project progressed steering
committee meetings evolved on a monthly basis to



                                                                                    5
      monitor the project and the evaluation
      identify the key target groups
      organise the finances
      plan the times and content of the forthcoming seminars
      review progress against the planned timeframes
      ensure the project continues to meet its stated aims

In between I met with members of the group individually to discuss various aspects of
the project. I also met with the Incontinence Co-ordinator in the Southern region to
get feedback, obtain suggestions and to include new ideas in the program.

The Commonwealth Department of Health and Aged Services also appointed an
external evaluator. (IEA) for the project Greta Mason, from the University of Western
Sydney with whom I consulted with throughout the project. Copies of each progress
report were sent to the IEA for assessment and feedback, and changes as
recommended were made. This advice was much appreciated. She was able to useful,
positive and creative suggestions or improving the project as it went along.

A number of suggestions were made by the IEA early in the project, including
checking the content of the workshop with Professionals. Following this suggestion I
met with Ruth Austin, Incontinence Advisor at the Incontinence Clinic, Royal Hobart
and Debbie Traill, Incontinence Advisor, Royal Hobart Hospital. Both checked the
planned program and found it appropriate for the client group. Two further meetings
were organised with Dr Assenheimer to discuss content and presentation for the target
audience. It was considered important that the language used for medical terms could
be understood by those attending, and to avoid raising anxiety about intensive
interventions in the workshop. The issue of explaining privacy safeguards was also
considered important in the content.

Regular meeting were held with the Incontinence Co-ordinators at the Royal Hobart
Hospital and the Incontinence Clinic located at the Repatriation Hospital in Hobart.
This Clinic is managed by the Department of Health and Human Services. They
viewed the work we are doing as important complementary work in addressing
important barriers by the target group in accessing their services. They said that they
had enormous difficulties in reaching people from ethnically and culturally diverse
backgrounds, and that this project was making important linkages in extending their
services to people who were unaccustomed to using main stream services because of
language, custom and belief barriers.



Population profile of middle to older aged persons from Non-English
Speaking backgrounds in Tasmania

The 1996 census shows that there are 9,840 people resident in the state from countries
whose main language is not English. Data from the 2001 census is not yet available.
The age profile of these older Tasmanians is set out in Table 1




                                                                                     6
Table 1: Country of Origin for Tasmanian persons born overseas aged 45 years
(Source 1996 ABS Census)


 Country            45-54       55-64       65-69       70-74       75+   Total
 Chile              21      7           5           0           3         36
 China (excluding   53      67          28          18          32        198
 Taiwan Province)
 Croatia            59      118         19          18          6         220
 Egypt              18      9           5           7           7         46
 Fiji               31      28          0           0           5         64
 Germany, Federal   551     382         298         163         116       1,510
 republic of
 Greece             171     195         42          22          20        450
 Hong Kong          33      19          5           3           4         64
 Hungary            39      67          45          32          44        227
 India              88      76          27          18          35        244
 Indonesia          39      17          6           10          9         81
 Italy              238     371         215         126         85        1,035
 Lebanon            13      0           0           3           0         16
 Macedonia,FYR      4       0           0           0           0         4
 of(a)
 Malaysia           97      46          5           5           3         156
 Malta              28      19          7           6           0         60
 Netherlands        910     560         203         165         290       2,125
 Philippines        120     40          10          4           5         179
 Poland             151     121         113         216         238       839
 Serbia      and    3       5           7           3           0         18
 Montenegro,FYRs
 of (a)
 Singapore          28      22          7           3           0         60
 South Africa       138     57          34          24          30        283
 Sri Lanka          31      20          4           3           4         62
 Vietnam            31      14          0           0           5         50
 Born elsewhere     839     656         441         303         324       2,563
 overseas (c)
 Total              5,682   4,516       3,383       2,045       3,042     9,840


From the table you can see that the major populations groups are: from Holland,
Germany, Poland, Italy, Greece. Most of the population from Germany and Holland
represent well established and integrated communities who tend to use mainstream
services.


                                                                                  7
Key facts about the overseas born from Non-English speaking countries for whom
workshops were specifically targeted are as follows.

The Greek –born
Limited Greek settlement occurred in Tasmania in the pre-World War 11 period
where 34 people immigrated to Tasmania. However during the 1950s and 60s more
immigration occurred to make Greeks the sixth largest European birth-place group
(Hugo 1986), although Tasmania has the lowest percentage of many overseas born
population groups.of Greek immigrations compared with other states. The first Greek
Orthodox community was established on Hobart in 1957. Immigration from Greece to
Tasmania subsequently declined. Work done by Graham Hugo in analysing the
spatial distribution of the Greek born population shows that they are located mainly in
Hobart.

The Italian-born
There was a major increase in Italian immigration after World War 11, Tasmania’s
Italian born population increasing by fifteen times shortly after the war, and became
increasing concentrated in Hobart over this period. In the early post war period a
number of Italian immigrants moved to Tasmania under a scheme whereby they were
contracted to work on arrival in direct employment for 2 years with the Hydro
Electric Commission or the aluminium works at George Town. During the 19502
there was distinct shift in the populations towards Hobart.

The Polish-born
There are a number of dominant waves in the pattern of Polish immigration The first
occurred in the early post war years comprising persons displaced after the Russian
occupation of Poland after WWII. In 1947 Tasmania had 47 Poles but by 1954 the
number had increased to 1593. Many were contracted to work for 2 years on arrival,
most with the construction of the hydro-electricity dams on the Central Plateau. Over
the years the population has become increasingly located in Hobart and Glenorchy
Only a small number of Polish-born now live outside this area.. Polish immigration
subsequently declined but a new wave of immigrants came later as a result of
disruption in Poland during the 1980s- but this later group generally falls outside the
target aged group for the MCOT project.

The Croatia- born
Like other southern European born the spatial distribution of Croatia-born shows a
distinct pattern of concentration. 75% of the Hobart population live in the Local
Government areas of Hobart and Glenorchy. A smaller population lives in
Launceston, with some small communities in mining areas.

The China-born
Chinese migration to Australia goes back into the nineteenth century with the
discovery of gold. In 1881 Australia’s Chinese population peaked at 38,533.
Thereafter the Chinese population declined with the White Australia policy.
Tasmania never attracted a large share of the nations Chinese. Around half of the
population live in Hobart.




                                                                                      8
Workshops
Originally it had been intended to hold a number of regional multicultural forums. I
then decided to trial a new approach of contacting individual ethnic welfare services
to organise ethnic specific workshops for different groups. This proved a great
success and workshops were organised for a number of groups which had migrated to
Tasmania and had a number of more elderly ageing migrants.


WORKSHOP PROGRAM
The following table summarises information about the workshops and number of
people attending.

 Community              Date                   Venue                     Number
                                                                         attending
 Multicultural Forum    24 July 2000           Polish Club               40
 Hobart
 Multicultural Forum    24 August              Good neighbour Council 43
 Launceston
 Multicultural Forum                          Devonport Community        52
 Burnie                                       Health Centre
 Greek                  20 November           Greek Welfare Centre       32
 Italian                29 November           Italian Club               34
 Chinese                22 November           Chinese Community          30
                                              Centre
 Croatian               14 November           Croatian Club              25
 East Coast visits      5 Dec. and 26 January Households


HOBART MULTICUTURAL SEMINAR

Publicity

We advertised our first program in 16 different languages in a variety of Media:
popular radio and ethnic radio, printed media included brochures (everywhere-see
attached brochure)
Printed brochures were in English and distributed to:
     Community Notice Board
     Salamanca Market stall holders (This is a large Hobart market which is held
       each Saturday)
     Multicultural Council
     Migrant Resource Centre
     Community Outreach
     Department of Health and Human Services
     Women Tasmania
     Royal Hobart Hospital Clinic
     Family Based Care
     Immigration


                                                                                     9
      RSL
      Southern Cross Homes
      Churches ( Catholic)
      Some employment networks

I contacted a number of specific ethnic groups (Polish, Italian, Croatian, Greek,
Dutch) to tell them about the program, including visiting the clubs and speaking
personally to older men their communities. Just about all the men I personally spoke
to came along to the Seminar, and this seemed to be a very effective method of
ensuring a good attendance.

My assessment is that the brochures were when left in isolation- not particularly
effective in recruiting attendees. Individual visits by me to ethnic clubs and direct
contact with likely participants was I think the most effective method of bringing
people to the workshop.


FIRST SEMINAR HELD
A seminar in Southern Tasmania for older men. 50+ was held on Tuesday 24 July at
the Polish Club and around 40 people attended.
The seminar was attended by men (a number of whom were accompanied by
partners). The birthplace of attendees was a follows:
     Sudan
     German
     Polish
     Indonesian
     Chinese
     Sri Lanka
     Indian
     Holland
     Ireland
     Croatia
     Bulgaria
     Italy
     Russia

The format involved a 2 hour presentation by Dr. Dwight Assenheimer, an overseas
doctor with 20 years professional practice who is currently teaching at the University
of Tasmania. Audiovisual aids were used and a large anatomical model of the lower
abdomen. The selection of a male practitioner from an overseas background was
discovered through conversation to be an important determinant of whether men were
likely to attend. One of the finds at this early stage is that one of the barriers for
certain migrant groups appears to be the lack of male incontinence nurses from ethnic
backgrounds, and this finding will be referred to the Department of Health Services to
take into account when making further appointment to these positions. McoT also
arranged for an experienced psychologist to talk on psychological aspects of dealing
with incontinence for the man and other family members. It is significant to note that
certain migrant communities like their wives to come with them, so I will be
including spouses in future invitations.



                                                                                   10
During the presentation and at the conclusion of the talk an opportunity was provided
for questions. A number of participants spoke privately with the doctor and myself to
obtain further information about services and products, and additional tips on
incontinence management. There was also time for sharing of information and worries
over lunch which was organised with the Polish Club. One individual from the Sri
Lankan community rose and thanked the Commonwealth for making such a seminar
available because he had found it so useful.

Individual Consultancy to follow up on raised concerns and to ensure that the links
made to services met the individual needs will occur over the forthcoming weeks.

EVALUATION OF FIRST SEMINAR
Evaluation forms were distributed to all participants at the conclusion of seminar
which sought information:
     Whether participants had felt able to ask everything they wanted to know
        about
     How helpful the answers had been
     Whether they knew who to contact if they had problems
     How much they knew about incontinence before they came
     How they now rated their knowledge of urinary system works and how this
        related to other parts of the body.
     How they rated the workshop in terms of content and length
     Whether there were other areas of health that participants felt they wanted
        more information about.
    
The session was seen to be of enormous benefit because they all received information
in areas they had not known about, such as Incontinence services, support groups and
other information services available through the Commonwealth.

Other identified areas of health information needs which participants of this workshop
indicated they would like more information on included:

      Diabetes
      Heart disease
      Dementia
      Aged Care Services
      Stroke

Evaluation Progress notes

Following feedback I resolved to choose speakers according the requirements of each
community to ensure that they will be comfortable with speaker. When advertising
the next seminar I decided to personally see many small ethnic groups, because it
appeared to be the most effective way of encouraging participation. I also decided to
contact interpreters for major language problem groups that were identified during the
pre-seminar visits.

Based on my assessment of the success of the first workshop I realised just how time
consuming the organisation phase was. I found that targeting individual ethnic
organisations through pre-forum visits was a crucial step in obtaining trust and putting


                                                                                     11
a face to the project. Informal face-to face chats with older persons prior to the
workshop was an important determinant of whether people were likely to attend. I
decided to make a preparatory trip to each region prior to the workshop in order to
meet with GPs, service providers, ethnic support groups and approaches to individuals
who are known to be in need of support. I decided to make the 3 forums in each
region a short day session with lunch and ask all relevant services to show-case their
information and aids. The program co-ordinator agreed to undertake follow-up
interviews and ensure that each person has been linked with appropriate services. I
also decided that links would be made to On-Line access Centres Support for any
individuals who are computer literate, but do not have access to computers and would
like to participate in any on-line support groups.

Following the First Workshop I reported and sought feedback from Greta Mason and
will be taking her advice on how to conduct the evaluation. She has also offered to
obtain incontinence information in different languages for future seminar, and this
will assist greatly. She has also advised that she is available at any time for support.

Further suggestions were made by Greta Mason (IEA) about the using the
Incontinence Foundation of Australia to obtain information brochures in different
languages whenever required, and I have used them since on 3 occasions, obtaining
information for languages spoken by the target audience. I also discussed the
importance of adding women and partners, because many men wanted to bring their
partners. The partners of multicultural men were also very interested in the program,
and encouraged their partners to attend. This seemed to provide moral support for the
men. In the Devonport workshop a number of families also brought their children-
many of the older men had younger wives. No childcare facilities were available so I
arranged childcare onsite with the Child Health Department.


LAUNCESTON SEMINAR

Planning stage
I spoke with many community leaders from different ethnic groups, the Migrant
Resource Centre and the non-English speaking community centre. On 10 August I did
a pre-visit (100 people attended for their AGM) and this gave me a good opportunity
to talk about the forthcoming program. I emphasised that this was funded by the
Commonwealth Department of Health and Aged Care, and was entirely free. At this
meeting I also distributed information and detailed brochures for those that would be
unable to attend the planned workshops. The material told them where to go for help
and where to get free local information.

Publicity
We advertised our program in the Northern Newspaper- The Examiner Community
Notice Board
Migrant Resource Centre
Library
Supermarkets
Department of Health and Human Services
GPs
Churches


                                                                                     12
Again looking at the attendees, brochures left in isolation was not as successful as the
newspaper and contacting community leaders. Individual presentations to potential
attendees was also very successful.

The Workshop
The Workshop was held on Friday 24 August from 10am –12.00pm with informal
follow up organised by the Good Neighbour Council itself.

The background of attendees (n=43) was as follows:
    German
    Polish
    Arabic
    Indian
    Greek
    English
    Indonesia
    Sri Lanka
    Holland
    Ireland
    Croatia
    Bulgaria
    Italy


The format involved a 2 hour presentation by Sue Delante, Incontinence Nurse
Manager, Kings Meadows Community Health centre, Health and Human Services

During the presentation and at the conclusion of the talk an opportunity was provided
for questions. There were many aged persons, well over 50 years at this Seminar.
Because of the aged group we planned to bring a lot of new products available to use
for Incontinence in the home, such as night bags, travelling protection (which no-one
knew about). There was an opportunity for everyone to see and feel the product
comfortably. We demonstrated pelvic floor exercises and encouraged them to
continue doing it. We selected a volunteer who was happy to ensure that in all future
Friday meetings of the Good neighbour Council pelvic floor exercises would be
practiced.

In summary, although the age group of the Launceston Seminar was significantly
older, the participants were very happy that the Seminar and information at the AGM
had been organised.

Evaluation of Launceston Seminar

Evaluation forms were distributed to all participants at the conclusion of seminar
Again the evaluation was positive- participants wanted more information about
Diabetes and Blood Pressure. Again people asked about information on Dementia.

A post seminar visit was organised in September with the group on a Friday to check
that the pelvic floor exercises idea had been taken up and to pick and up any further


                                                                                     13
questions. After the Seminar a number of participants had made arrangements to
revisit their GP for a physical check up.

DEVONPORT SEMINAR

Planning stage
In preparing for the Devonport Workshop I liaised with the Incontinence Nurse
attached to the Community and Rural Health Section, of the Department of Health
and Human Services. We redrafted to brochure to an A4 flyer with an Action message

PELVIC POWER FOR SENIORS!!
Learn techniques to plug leaks.
Information on bladder control, how to cure, improve and better manage

The Workshop was organised for the Devonport Community and Health Centre, and
bookings could be made by contacting either myself (on mobile) or the regional
Health Centre.

Publicity
People consulted in the planning phase were:
Pat Maddox- Health and Human Services
Judy Lee- Community Nurse
Dr Nauker- many non-English speaking patients
Men’s Health ( Tony Lee)
Voluntary worker in Nursing Homes and GP surgeries (Judy Wild)
Migrant Resources Centre (Marcus Ritchie)
Ethnic homes in the Community including the El Salvadorean and Egyptian
community

The Workshop
This was the most successful Workshop in terms of numbers with 52 people
attending. People from the following countries came:

El Salvador ( 10 people came, largely in response to the earlier home visits)
Ireland
Italy
Greece
Czech Republic
Poland
England
Holland
German
Australians – who were born here who also heard about it and wanted to come. Many
were women.

Again we changed the workshop format, as follows to encourage people to identify
what they wanted to know about before we commenced. We wrote up all the issues on
a blackboard. This encouraged participation very early on in the workshop. A lot of
people began to share their worries and anxieties early on, and we addressed each one.



                                                                                   14
The following format seemed to work the best of all workshops and should be
adopted in developing the model:

Pelvic Power Workshop

Session 1 (Duration: 1 Hour)
   1.      Welcome-introduction-cup of tea etc (15min.)
   2.      What you want to know about?- blackboard- asking, clarifying and
           facilitating more questions
   3.      Overview of what is to be covered in the session
   4.      How the bladder works-Why it might fail- Main types of continence
           (30minutes)
   5.      Questions and Answers.


Session 2 (Duration 1 hour)

   1.      Good bladder habits (10 minutes)
   2.      Pelvic floor exercises +ten minutes relaxation exercise) –10 minutes
   3.      Contributing factors- constipation, hormones, women’s health
           gynaecological checks (10 minutes)
   4.      Diagnostic procedures for enduring incontinence (10 minutes)
   5.      Questions and Answers

Lunch: Contracted provider

Evaluation

The evaluation form was changed and made more simple:

We had 3 boxes: (and a Snoopy cartoon)
The first box said: The two most important things I have learnt from today are……..
The second box said: As a result of my learning I will………..
The third boxes: Comment on how I found the presentation of the Course: Positives
and Negatives

The evaluation forms were extremely positive.

The Seminar was very practical and they were keen to keep up pelvic floor exercises.
The attendees asked for more information about pelvic floor exercise and the
Incontinence Sister has arranged to send them out.


HOBART- Greek Community

Planning stage
I visited the Greek community at the Greek Welfare Centre several times to
familiarise myself to potential participants. Most of the people attended the Welfare
centre were aged 55 to 80 years. On the first visit I was like a stranger to them and
they did not open much despite my efforts to engage them in discussion. I realised a


                                                                                  15
second visit would be required to ensure reasonable attendance. On the second
occasion people accepted me much more readily and knowing that I was from
Multicultural Tasmania seemed to provide reassurance together with my nursing
background. Many questions were asked and this provided an opportunity for me to
encourage them to attend a more detailed session. It was apparent from this second
visit that incontinence is a major health issue for this particular ethnic.

Publicity
We advertised our seminar in 92FM on 4 occasions
Brochures were given out at the Welfare Centre on 2 occasions for distribution in the
wider community

The Workshop
The Workshop was held on Tuesday 20 November from 12.30- 2.00pm with follow-
up occurring at the Welfare Centre one-week post seminar to check that the
information was useful and answer any new questions.

Attendance
The workshop was attended by 32 people- 22 were men. All were of Greek origin.

Presentation
The format involved presentation by Dr Dwight and a Greek Interpreter, (a social
worker known to the members). The doctor used diagrams and spoke for maybe 45
minutes with the Interpreter. He was very informative and was able to hold
participants interest for the entire presentation. People had the opportunity to ask
questions during the presentation, and a few participants asked during the
presentation. At the conclusion of the seminar, we had a Greek meal and the doctor
and myself met people individually. This was a most productive time and many
questions were addressed.

Participants were given an information pack in Greek for home use.

In the follow-up visit I did pelvic floor exercises with several small groups in 3 rooms
and answered additional questions. This was also very productive and I am planning
to see them again shortly for additional assistance. They are requested continued
support with their Incontinence issues. They have also requested assistance with
diabetes and blood pressure health issues.

Evaluation of Seminar held at the Greek Welfare Centre

No evaluation forms were distributed to all participants for this workshop although
the verbal feedback was extremely positive and contact is ongoing. Father Tim who
runs the Greek Welfare centre has undertaken to remind participants of the
importance of using the information and continuing the pelvic floor exercises.

SEMINAR –CHINESE Community

Planning stage
I spoke with the Support Worker for the Chinese Community, and visited the Chinese
Community in Moonah. When I first visit I spoke to about 25 people and encouraged


                                                                                     16
to bring more friends to the planned Seminar. At the first there was (in contrast to the
Greek community) much support for hearing more about the issue. I also arranged for
an Interpreter for the Seminar with the Migrant Resource centre.

Publicity
Again I used 92 FM to advertise, and gave flyers out during my first visit.

The Workshop
The Workshop was held on Thursday 22 November from 10.30-11.30 followed by
lunch. 30 people attended the workshop- 10 were men. Most were ageing Chinese
women. Most of these women had incontinence problems.

I had arranged for Dr Dwight to again run the seminar because of the success of the
Seminar at the Greek Welfare Centre. Unfortunately he was delayed so I took the
opportunity with the help of the Interpreter to run the Seminar myself. I spoke for
around 40 minutes with the assistance of the Interpreter. Again many questions were
asked at the end of my talk.

At the end of the Seminar I handed out an Information package in Mandarin and
stressed the contact numbers for assistance. Some matters seemed to be of more
concern to this community. They were the confidentiality of Government
Incontinence Services and the availability of female staff. During the lunch I talked
individually with many of the participants. They appeared to want to talk more
privately than other groups about their Incontinence problems so I set up a quiet table
in the corner of the room so they could candidly discuss their problems in private.
This seemed to instil more confidence. I also provided more home number and said
that I would be available I needed.

Interestingly, the Bus Driver, a participants in the group offered to do pelvic floor on
the bus and all agreed it was a practical idea they would like to take up. It seems that
while it was to discuss the group were more than will to collectively practice the
exercises.

SEMINAR –Italian Community

Planning stage
I organised a meeting with Natalie, organiser of the Italian Pensioners Club to discuss
whether organising a seminar on Incontinence would be useful within the
Community. The result was positive so I organised a pre-visit to the group in October
to discuss the proposed Seminar.

I also contracted with an Official Interpreter for the session.

Publicity
Again I used ethnic radio on 92 FM to promote the Seminar as well as the pre-visit at
which I distributed flyers.

The Workshop
34 people attended the Workshop which was held on Thursday 29 November 12-
4.00pm (the longest session so far!) at the Italian Club in North Hobart. Fifty percent


                                                                                     17
of attendees were men. A number of men came by themselves which was more
unusual compared with other workshops.

Dr Dwight spoke with the assistance of an Interpreter for around 45 minutes. There
were many many questions and the doctor also stayed until 4.00pm due to the interest.
An information package was given in Italian after the presentation, and luncheon food
was provided.

Evaluation forms were distributed. The response was very positive, participants
indicating they would like more seminars. The identified issues for this community
were: diabetes, blood pressure, dementia and obesity.


SEMINAR –Croatian Community

Planning stage
This was the most difficult of all my workshops to organise. I do not know why this
was so, but it required much more commitment and persistence on my part, and
continued liaison with community leaders to bring it about. I contracted a private
Interpreter for the planned session and organised catering.

At the end of the negotiations I managed to attend their Annual General Meeting to
explain about the importance of the incontinence information for ageing Croatians.

Publicity
I used Croatian radio programs and flyers, and also their leader explained about the
forthcoming seminar.

The Workshop

In the end 25 people attended-all men. The Workshop was held at the Croatian Club
in Glenorchy on 14 December 2001. The form of the Workshop was a 45minute
presentation by Dr Dwight including slides. An opportunity was provided for
participants to ask questions during and at the end of the Seminar. Pelvic Floor
exercises were demonstrated. A package in Croatian was distributed at the end of the
Seminar.

All of the participants said that they had found the workshop useful and suggested
they would like more information on diabetes and dementia.




                                                                                  18
Regional Tasmania The East Coast Community
Planning

Early planning consisted of visiting the local general practitioner in St Helens to
discuss the problem and to identify the location of the target population. I also took
the opportunity to distribute the information at a large gathering that was occurring at
the time of the visit, which was attended predominantly be older aged persons. At this
gathering I was able to talk individually and with small groups, and answer questions.
A number of women introduced their husbands to me at the gathering and I was able
to provide information to them. In organising my east coast visit I also talked with the
Migrant Resource Centre in Launceston. In addition I already had some established
contacts in the region due to an earlier McoT consultation with migrant women in the
community health centre in 2000. The migrant population in this region was different
than that of other regions. In this regions there are a number of younger Filipino
women caring for older aged husbands with health issues, such as incontinence
problems. A number of the husbands were of Tasmanian origin (roughly 50%), the
others being from Croatia, China, former Yugoslavia and Italy. In organising this visit
I had an established contact in the region from the Philippines, who had been in
Tasmania 23 years and who knew the East Coast community and had established
community connections. This was good because the contact already could identify
particular problems that families had and may not have been confident enough to
mention in a group situation.

It seems that community visits in smaller groups work well because they have the
confidence to air their real problems. This seems specially so when an outside person
with professional expertise can talk with them and provide information about where
they can get help outside their community more privately. Many people feel unsure
about fully disclosing what is going on their lives within a small community because
they feel that it may be safe, even though services in the area have confidentiality
guidelines. For example, there is only one medical practice with 3 doctors.

Publicity
I sent information by post to my contact who contacted the people and I made
personal telephone calls to others to pass on information.

The Workshops

On 7 January I visited the GP in St Mary’s and advised him on available incontinence
information, including the National help Line and the range of available languages for
information on Incontinence. I also one family where I was advised by the Doctor that
a problem existed, and spent some time with the family discussing incontinence
management and services. Information was left with them to distribute to 2 other
families which they knew were having difficulties. I also distributed information to
the local community health centre in St Mary’s.

In January I travelled to the East Coast on January 26 and visited 4 households. Each
of the households had arranged for other interest families to come so that the
information could be shared amongst the group. I spoke to families about



                                                                                     19
incontinence and its management, provided them with information in the appropriate
languages, and answered questions.

The issue of confidentiality was discussed. Many of the older men had said they had
been embarrassed to discuss the problem with the female GP. . I talked with the local
practice and reassured people that they could see a GP – either male of female- their
choice. I also discussed the confidentiality principles under which medical practices
operated. I helped people realise that they could change between the GPs without
feeling disloyal and uncomfortable and that the GPs would fully understand their
reasons for choosing a doctor of the same sex.




                                                                                  20
OBSERVATIONS AND RECOMMENDATIONS
General
    Overall the Seminars were a great success and appreciated by all the
      communities. Information provided by the Incontinence Advisory Unit,
      Repatriation Hospital, Department of Health and Human Services has advised
      me that the number of referrals from ethnic groups have increased since the
      workshops occurred.

Advertising
    Using ethnic radio stations was much more useful then general newspaper
       advertising

      Preparation work is of the utmost importance in gaining trust – to be able to
       put a face and voice to the program before holding the workshop. Early
       personal contact inspired enthusiasm to attend.

Organising the Seminars

      Health care away from the hospital environment in surroundings which are
       familiar were much appreciated. This means often going to where the energy
       and existing activities are occurring in fitting in around these programs to
       provide the training, as occurred with the specific target group workshops.
       This also means that follow-up can be undertaken in a more cost effective way
       and further workshops organised much more easily.

      It was apparent that project success was due to having a co-ordinator from an
       ethnically and linguistically diverse background with expertise in the area.
       This appeared to lead to a ready cultural acceptance.

      Working hand-in-hand with Government, community leaders, and community
       organisations is important in organising seminars and good collaborative
       working is essential to making a successful program.

      Since the workshops I have been contact by Government asking about how to
       best help other projects (such as Breast Screening and other women’s health
       issues) in making contact with people from ethnically and culturally diverse
       backgrounds. In delivery mainstream services providers are often away that
       this target group misses out.

Other Health care Needs important
    Participants would like more information available on other aspects of health
      care- such as heart disease, dementia, diabetes and blood pressure.




                                                                                 21
Reinforcing learning

      Programs should be repeated regularly to reinforce learning. It is suggested
       that a series of annual workshops occur which focus on a range of health
       issues, but that participants can raise issues from earlier workshops including
       incontinence management. This recommendation is fully supported by the
       Incontinence Management Advisory Units.

      The provision of information in their own language, given in folders to take
       home later and used- was appreciated-because the information is always there
       for them.

      Follow-up strategies are important- particularly daily reminder strategies. (For
       example, the Chinese Community bus-driver agreed to remind people to do
       their pelvic floor exercise in the bus and to use an exercise tape.)

      More information in other languages in public places, like conveniences in
       shopping centres, bus shelters, GP surgery waiting rooms.

Information for Service providers

      Participants would like GPS to spend more time discussing their health needs,
       and that the GP initiates discussion about their needs by giving a general
       health questionnaire to people while waiting for their appointment. This
       provides some comfortable for them to initiate a discussion of their health care
       needs. This would assist barriers in communication which prevent people from
       CALD backgrounds from initiating discussion of issues.

      An increase in male nurses in incontinence nursing advisory work, would also
       alleviate anxiety about discussion incontinence with women advisers. A
       choice should be provided.




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Appendices

1.       Brochure

2.       Pelvic Power Workshop for Men

3.       Evaluation (example)

4.       Radio Announcement

5.       Contact information for participants

6.       Pelvic Power promotion Plan for North West




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