The dynamic role of a remote outreach public health dietitian, with Gina Absalom

Gina talks about her work as a public health dietitian working closely with community members and other key stakeholders in remote Central Australian Aboriginal communities. Gina emphasises embedding research into practice, the role of capacity building within the nutrition arena, and community ownership and empowerment within food and nutrition strategies and programs.

Links to the Northern Territory Nutrition & Physical Activity page can be found here, and to get in touch with the Remote Dietitian Network email NutritionOutreachCA.doh@nt.gov.au

Contact Gina via LinkedIn or Twitter

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CREDITS

Host: Sophie Wright-Pedersen

With thanks to Gina Absalom for her time and thoughts

The Foodies in the Field podcast would like to acknowledge the traditional owners of the land on which this podcast was made, the Turrbal and Yuggera people, as well as the lands from where Gina was speaking and where you may be listening from today. We pay respects to elders both past and present and acknowledge that Aboriginal and Torres Strait Islander people were the first foodies of this nation. 

Transcript

Sophie: [00:00:00] Welcome to Public Health Nutrition from Foodies in the Field, a podcast showcasing stories from passionate foodies about who they are and what they do. I'm Sophie Wright-Pedersen, your podcast host, and on today's show we have Gina Absolom. A public health dietician with the Northern Territory government.

In this episode, Gina talks about her role as a public health dietician, working closely with community members and other key stakeholders in remote central Australia, aboriginal communities. The diversity of these roles is remarkable, spanning clinical caseloads to community driven programs, to school nutrition programs, and even changing food store layouts to nudge people towards more nutritious food choices.

Hi Gina. Welcome to the show. 

Gina: Hi, Sophie. Thanks for having me. 

Sophie: We're gonna get started by just asking you what your favourite food experience has ever been. 

Gina: One that kind of aligns with my food values is a couple of years ago I was doing a hike in Tasmania with some friends and we were eating some very basic meals like rice and one vegetable. One of the nights we made Deb, which is instant mash potato with a little bit of garlic and rehydrated peas and that was a great food experience because we were so happy with how good it tasted despite it being one of the most basic meals I've ever made. It just goes to show that the context in which we eat food is so important to how much we enjoy it because I can guarantee if I made Deb and Peas for dinner tonight, I would not get the same amount of joy. 

Sophie: There is definitely something about hiking and just being so completely exhausted and then eating really salty and just really basic foods that you've carried from maybe over 20 kilometres or whatever it might have been. You are a qualified dietician, Gina, and you've been working as a public health dietician for about two and a half years now. What led you down the community nutrition path and what have you done so far? 

Gina: Yeah, I think I went into my master of dietetics very focused on becoming a clinical dietician and working in a big Melbourne hospital but pretty quickly deviated from that career path after actually doing clinical placement. For me, it was a combination of working with clients in the hospital setting who do come in with preventable chronic conditions that you end up having to manage in an acute or subacute setting. Also having the experience of coming back to Alice Springs, which is my hometown, to complete my community nutrition. Returning back to Alice, opened my eyes to the role. Well, actually it's the role I do now. Still having that opportunity to work one on one with clients but working on broader public health nutrition projects and a focus on prevention as well. 

Sophie: Was Alice Springs the first job you got after you graduated university?

Gina: No. I ended up going to Broken Hill for a small stint and worked for an aboriginal control organization there. So I was one of two dieticians that was based in. Broken Hill, but also provided outreach services two days a week to Wilcannia. And we went to some other places in Far West, new South Wales as well.

So I was only in that role for a short period of time. And yeah, I suppose I made the difficult decision to leave that organization after six months and come back to the Northern Territory because I was offered a position with the remote nutrition team. Doing pretty much a similar role. So providing outreach services to remote aboriginal communities.

But I suppose the distinction between the two roles for me was the opportunity to work in a more experienced team and have more support from dieticians around me, which I think is very important when you are entering the workforce. 

Sophie: In your team there's, there's six dieticians just in the remote outreach team. When you're talking about it you mentioned in both the Broken Hill role and the Alice Springs or the outreach remote role based in Central Australia, there's the outreach service that you're providing. What do you mean by outreach services? 

Gina: So that's basically where we pack up our bags and go travel, you know, anywhere from two to eight hours depending on what community you're going to and spend, you know, four to five days staying out in community and providing a combination of clinical nutrition services.

So that's just seeing people through the clinic who are refer, referred to you. And then we also have a public health nutrition workloads. So that's anything from working with remote food stores to providing group education at schools and, you know, upskilling staff and school [00:05:00] nutrition programs, clinic staff, aboriginal health practitioners.

So I suppose the outreach is, I suppose it's called outreach because we are based in Alice Springs, but the actual delivery of our service happens elsewhere in a number of different communities. 

Sophie: I guess for those who haven't maybe been to Central Australia or haven't been exposed to this space before, how far away do people kind of like, what would be the furthest or a typical kind of travel amount for someone who would be providing an outreach service?

Gina: So I've got quite close communities. So two of mine are between two and two and a half hours, and the furthest away would be four to five hours, depending on road conditions. But we do have teams who travel out right near the WA border. And that's about an eight-hour drive. Oh, so that's insane near the Queensland border, and that's probably a little bit over eight hours.

But most people tend to fly out there because of the drive is, is very long. 

Sophie: Like you said, you, you stay out in these communities for the whole week. What's kind of the, I guess when you're in these communities, like what's kind of the day-to-day activities or kind of routine that you get into and where do you stay and kind of what does it look like when it actually out on that community 

Gina: Where you stay definitely depends on what's available within your community. We tend to stay in like health clinic accommodations, so just really basic houses that have kitchen, bathroom linen beds, you know, all your basics are provided for you. And generally we would pack all our food for the week. And take it out with us because it can be you know, remote food store prices are quite high and you're not always guaranteed to get things you're after so we tend to bring literally everything we need. Day to day can look quite different depending on think a number of factors. If you're more established in your role, you're definitely going to have, I suppose, stronger relationships within the community. So you might be a little busier versus when you first start in a role like this where it might take a couple of months or even a year or two before you are really trusted within that community, tend to do on travel days, we'll spend the afternoon following up clients that have been referred to me. So trying to do those clinical caseloads on the days where I have less time. I suppose from like an organization point of view, if you were to arrive in community and go straight into group education, I suppose sometimes you might feel a bit flustered or you don't know what's gonna happen in the morning that you're traveling and you might get held up if you have to like take a nurse out, take, you know, covid 19 vaccinations. I tend to keep those travel days more for the clinical caseload or even just stakeholder catchups just because it's a bit more flexible versus when you're locked in for a group education and then you have time to double check. Because sometimes things have happened in community and it might not be appropriate to be doing, going into a certain service.

Sophie: What types of things would they be? 

Gina: The main one we consider is, sorry business and a lot of the time. We probably wouldn't be traveling to that community just to be respectful that that's a period of mourning for the community and they have other priorities at that time. There is a general rule that you shouldn't go into a community when they are in sorry business. 

Sophie: What do you mean by sorry business.?

Gina: Sorry business is a part of aboriginal culture where if someone's passed away, and it is where people mourn the loss of that person and, the duration and size of it will depend on who's passed away. If it's an elder in a community, sorry, could go on for quite a while because that's a really big loss for that community. You can have people coming in from other communities that have family connections as well. So sometimes you're actually out in a different community and you hear that, sorry business is happening the community over. So you might have a really quiet week. 

Sophie: Is there anything else that you would consider, like if you talked to people, would there be anything else that might stop you from doing certain things or other things you've come across that have delayed maybe doing stuff?

Gina: Men's business is the other cultural business that we are mindful of and that generally happens anywhere from November, December to January, February. That's a time that, particularly as a female, I probably would not go into a community. You can touch base with clinic managers, the council, if you have Aboriginal health practitioners working in the clinic, they're probably the best people to guide you on the cultural aspect, and sometimes there can be community unrest for whatever reason. That doesn't happen often it is standard practice to call before we go out bush, just in case something has happened over the weekend. 

Sophie: Thinking [00:10:00] about the public health-based nutrition work that you do in communities, what are some kind of broad things that you would do?

Gina: Our team kind of works under four different portfolios and that guides the type of public health programs and projects we might be doing. We have a chronic disease portfolio, in the past there's been a big project around sugar sweetened beverages and educating people in community around that. Talking to stores about what they can do to reduce the purchasing of things like Coke. There's been some radio ads in some of the communities as well, and chronic disease. We also do some workplace health promotion as well. And then we have our food supply portfolio. So I suppose that's mostly related to school nutrition programs that most schools provide and also childcare services and aged care services tend to provide food for community members. So we have a role in supporting those types of services in menu planning, suggesting menus modifying recipes. We usually do an annual training with like age care coordinator staff, so last year we did it around malnutrition and what they can do within their setting. And also, and I suppose explaining the importance of, you know, eating higher protein in older clients.

Sophie: With the school nutrition program, what does that involve? 

Gina: It's where breakfast and lunch and like a snack break are provided to the school. We have quite strict guidelines for school nutrition programs cause I suppose it's really about setting up those healthy eating habits early in life so that children are more likely to go on to have healthy eating habits in their adulthood. So we have guidelines that work off of traffic like systems. So green foods, which are everyday foods. So your core food groups, and then you have amber foods. So foods that you can provide sometimes, but not every day. So red foods would be, you know, high sugar cereals, high fat, high salt foods anything overly processed like pies and pastries sausages and soft drink. That's like a role that we can do is if there's new products that people want to use, we can look at those nutrition criteria. But we also have done some upskilling around that as well. Particularly recipe modifications because you might have sauces and things like that, that are pretty standard in a recipe, but they fall within that red category, so that can be limiting to the services.

Sophie: And even thinking, like talking to that, cuz you mentioned it a couple of times, like with upskilling staff, it seems like it's quite a core part of the work that you, you and your team do. What is it about that and why, why is that such a priority within your work?

Gina: Yeah, I think capacity building is really important. In a general sense, I suppose it's empowering for those services, but I think particularly important for our team is that we have limited time on the ground. We can't be there all the time. So if we know that people have the skills and knowledge to apply basic you know, nutrition, literacy to recipes and have that basic understanding or even, you know intermediate or advanced understanding of nutrition, when we're talking about upskilling, we're really talking about capacity building with the services that we work with. Most your communities are only getting a four- or five-day visit once a month. I suppose considering that we're trying to fit in all our clinical work and, you know, a number of different public health activities, you kind of are rushing around and really press for time so you do have to prioritize. So if you can give those skills and knowledges to services, I suppose it just gives them a bit more independence and they do have to rely on you less. Yeah, I suppose particularly when we are working with Aboriginal communities as well. I think it empowering for them to have those skills and knowledge.

Sophie: And also I think within that, by having those skills, then they can adapt that to be more like culturally appropriate to their context and also communicate it in a culturally appropriate way that we might not be able to do at the same level. 

Gina: Yeah, I think that's a really good point. Really. I think it's becoming more and more important in like health service delivery as well. You know, that aspect of capacity building. Definitely an aspect of our role that is really fulfilling and yeah, you get really great feedback and great engagement from services. 

Sophie: You mentioned that you had four portfolios, and I think we only got to two of them. What are the other two portfolios that your team works on?

Gina: We do have a clinical portfolio, so that would be based around referral guideline, prioritization guidelines and I suppose looking at professional development within the clinical [00:15:00] space. And then we also have our child and maternal health portfolio. So yeah, again, lots of upskilling working with child health nurses, introduction to solids education and aspect of that is also looking at what the infant food suppliers, like in remote stores and making recommendations around that. You know, for example, we want products to say six months plus, not four months plus on their labelling in line with world recommendations for introduction of solids. That came about because there were really high rates of anaemia in children under five. So I suppose there was an approach from child health nurses, dieticians and GPS to kind of look at what strategies could be implemented to improve childhood anaemia rates. Which is, it is a big reason that we would be referred to a child as well. 

Sophie: You say you have four portfolios, you've got seven people on your team. How does that work with managing those portfolios and the projects that sit underneath them? 

Gina: Generally our team lead won't really sit on a portfolio, so then that leaves six of us including the, our Barclay position to be on the working group. So we have three people per portfolio. So you end up sitting on two. So for example, I lead the chronic disease portfolio, but I also sit on the food supply portfolio. Generally it is looking at those broader projects that we, we would be doing across our different communities. There are projects that might just be delivered in one or two communities that do sort of meet our goals and objectives for a portfolio. You know, having those resources that you might develop and use available to the whole team is really important. So all of our portfolio work does sit on like a shared drive, so we all have access to it. And, and I suppose we all do work across all four of the portfolios, but you might just have, you know, the people who are leading and sitting under a portfolio working on tasks that relate to you know, clinical portfolio more often, and then if they need feedback, we would extend that to the whole team. But I suppose it's things are just pushed forward with the people working under that portfolio. 

Sophie: Yeah. Right. That's really interesting. And then are there any specific projects that you're currently working on or you've previously worked on?

Gina: So I'm currently working on a women's health project in one of my communities called the Sugar Sisters. So it's very much in that planning, implementation phase. And it's come about I suppose, from express needs of women. In the community that I work in. These women are looking for ways to improve their health. But we do find that there's often limited opportunities to do so within remote communities you know, that's anything from. You know, lack of access to, you know, supportive environments. So, you know, we have gyms and foot paths and, you know, sporting opportunities when you're in a more urban setting, but we don't find that as much in remote settings, particularly for women who might be middle aged or older. You know, it, it’s really a joint collaboration between nutrition, which is me and chronic disease, which is a diabetes educator and chronic disease nurse educator and the community. So we are trying to take a co-design approach which is where the participants of the program will also be involved in the planning and design of the program. And I suppose that's to do with the community, having ownership over the program and having that self-determination and empowerment. You know, these women will get to see a program that they get to participate in, but they've also been able to design. And I think from like a health service point of view, we are really seeing a shift from like clinician led healthcare to where clients becoming more involved with their healthcare decisions. And I think that's particularly important whenever you're working with you know, first Nation populations to really take their lead on things. Yeah, I suppose there's been lots of programs that have been implemented in the past and there are issues around sustainability, you know, whether that be high staff turnover, loss of funding, which, you know, very common things, particularly in a remote setting. So I think trying have that community ownership over program, you know, that's really focusing on chronic disease, self-management, but also inviting people, you know, family members to come along, to focus on that prevention side as well.

Sophie: Is there anything that you think's contributed to an increase in co-design being implemented within setting that you are in? 

Gina: Well, I think community consultation has always been kind of this buzzword that we've used when we're working with Aboriginal and Torres Strait Islander populations. And I suppose if you're looking at the level of participation, consultation is at the very bottom. Like telling people [00:20:00] that you're going to do something can, how do you feel about that? Okay. But we're. You know, you're probably still gonna go ahead and do it regardless of their input. And I think, you know, looking at wider policies, you know, we have the Closing the Gap strategy, which is probably our number one policy around Aboriginal and Torres Strait Islander health and wellbeing. Which has completely failed after, you know, over being implemented for over a decade. And I think aspect of that is because it isn't being driven by the population that is at the centre of the policy. You know, as a health professional, we're well trained in a particular area and we have expertise which is valuable and that we can provide to people. But it's about you. You, I think you've mentioned it before, you know we're never gonna understand that cultural context. You know, I'll never be culturally competent because I'm non-indigenous Australian. So I think having that input increases the cultural safety of your programs. And I think that increases engagement.

Sophie: Definitely. And I think something that's really critical that you kind of touched on is the fact that the idea for this program, the Sugar Sisters, the idea for it or the expressed or the need, it was an expressed need. It was, it came from the community, I think typically. What has happened is that within healthcare, when we go, oh, there's, you know, we're gonna do a needs assessment, and we do the need needs assessment on a specific type of need, which is we go and look at health statistics and we go, okay, there's 70% of this community has got diabetes type two diabetes. And so we go, okay, well we need to do something about reducing people's soft drink intake. And then we go, well, we're dieticians and so let's educate the community on reducing their soft drink intake. And, and you know, I think with your team, which is really good, you've also worked with like the stores and you're working across that health promotion spectrum. But that's not a need that's been identified from the community. That need was identified from the, you know, us as clinicians and then we'll go in and do consultation around reducing soft drink intake. But you know about like, oh, like what contributes to soft drink intake, but that might not actually be a priority for that community. And when we are talking about diabetes, like you've kind of pointed to with this program is it might actually, they, they actually might be more engaged in doing something that is a physical activity based program rather than a soft drink reduction program. And, and we need to recognize that even though that might, I don't know have the biggest impact when it comes to reducing people's HbA1c levels. If we can get better sustainability in those programs, we're probably gonna see better outcomes, especially in the long term. So like, what are we really aiming for here? And so I think even at the needs assessment stage, We need to incorporate community in that part of it.

Gina: I think as well, you sort of touched on it, like we look at health statistics, we look at the literature, and what we're really doing is looking at everything through this deficit lens where I think when you're looking at co-design, you really are looking at, well, what are these community strengths that you have and how can we build on that? And incorporate that in something that's gonna be useful, appropriate and something that the community wants to see. 

Sophie: Anything else you wanted to touch on with the Sugar Sisters program? 

Gina: We are currently have funding at the moment through the Bill Raby Diabetes Fellowship that is sitting with the Food bank branch in Alice Springs. So if people haven't worked in the government sector before, they might not be aware that, you know, everyone thinks the government's got a lot of money. Unfortunately we don't. And we are also, I suppose because we work for the government unable to apply for a lot of grants. So it can be really tricky in that side. And I suppose that's where when you're working in public health and in community nutrition, those relationships that you have with stakeholders are so important. And yeah, I suppose we're really lucky to have gotten food bank on board because you know, they are, you know, the food is a lot cheaper than a usual supermarket or remote store because we have the monies, the funding sitting with food bank. So we have access to their warehouse so quite heavily discounted food you know, to be able to provide cooking classes. So that has been something that's really been identified by women, is something they, they would like more of. And I suppose the benefit of also working with food Bank is that it does allow us to refer vulnerable clients into their system. So people will be given the opportunity to get a, a customer pays voucher, which means they still have to use their own money to purchase food, but we're able to provide them access to you know, free fruit and vegetable and bread and really [00:25:00] discounted core food items that might cost a dollar or $2. 

Sophie: Yeah, absolutely. Because especially if they're coming from a remote, from a remote community, what's kind of the pricing out in those remote stores that you've experienced?

Gina: Yeah, I think it's important to recognize that there always will be inflated prices because there are logistical difficulties to get food to particular areas. You might see it a little bit more in like Northern Australia where you have islands and wet seasons where things might have to be flown in or, or sent over on a barge. But I, I think that's important to recognize that, that you know, the prices aren't just more expensive because they can be, there are legitimate reasons. But generally we would see them two to three times what you would find in an urban setting. And that's for basic food. I would say like more around that convenience side is where, is where if we're looking at the remote food supply, I think you can have greater impacts. 

Sophie: And why do you think that is?

Gina: It can be related to the health hardware that people have at home. So they might not have good storage facilities like a fridge, freezer, or even a cupboard. Just something that we might hear reported to us from clients is if they do try to buy food and store it, because aboriginal culture is very much about family and sharing That also relates to food.

Sophie: This is where price I think does come in because it's not that you don't want to share food with people. It, it's that possibly you can't afford to share food with that amount of people. 

Gina: Absolutely, and I, and I think sometimes that's why we do see people up for convenience foods because it means that you can just go to the shop and you can buy something for yourself and like your immediate, like the family that are there with you also, you know, and not have to share it with, you know, 10 to 20 other people. That's also a really big strength on the other hand that we see, whilst people might be running out of food because other family members are coming and, and having it as well. I suppose that kind of has a flow on effect that, you know, you know, someone might get paid today so they buy the food for the family and then someone else gets paid on Monday, so they buy the next lot of food.

Sophie: Yeah, definitely. And I think it's such an important point to make. You're talking about stores before, like what kind of work have you been doing with stores? 

Gina: The reason why remote stores are a big focus of our worker at the moment is because we are, do have some collaborative projects. With Monash University, I'm sure if anyone's interested in you know, remote stores policies that have been implemented they've probably had the name Julie Brimblecombe and also working with Megan Christian. What we're looking at is utilizing an app called Store Scout. Basically we're looking at the food store environment and assessing it using an app. So we're focusing on the four Ps of marketing, so product placement, pricing, and promotion and I suppose that's typically used to probably increased purchasing of, you know, unhealthy items. So we've probably all seen like two for one sales. It's all looking at how you can manipulate the store environment to make it easier for people to purchase healthy products. So what the app does is asks a series of question that looks at, I think it's seven different food categories, looking at where they're placed are there any pricing, promotions, and, and how much product range do they have? The app, Is able to provide a bit of an assessment of the overall store environment and it gives the shop a score, I think out of 100 based on what you answered. And then it will go on to generate a list of recommendations of strategies that the store could implement to improve their food store environment. So that could be anything from reducing how many rows of confectionary items have displayed to, you know, putting a fruit basket at the checkout. And also I suppose I really like, really like this fact if you take like full sugar coke out of the fridge and have it at room temperature, it's actually been shown to decrease peoples purchasing of it and they're opt for something like Diet Coke or Coke, no Sugar, because people are after a cold drink. So, you know, it's not necessarily about the stores completely getting rid of discretionary foods. It's just about working with them, you know, figuring out what's feasible for them to implement and see if that changes the score that Store Scout gives. 

Sophie: with the store scout, would it be possible that anyone could use the app and do that assessment and get like a print out of the recommendations? 

Gina: The intention of this is really, again, around capacity building and, and it, no, it's not necessarily designed only for [00:30:00] nutritionist or dieticians, but I suppose the intention is that anyone working in food stores would be able to utilize this. So you know that store managers. You know, people within the community or, or like non-nutritional health professionals who might be working with stores as well. And I think it's having a tool that you know is evidence based and really provides objective feedback is a great way to work with store managers. I think sometimes you can face resistance from, I, I suppose, people who are trying to run a business. So it's really important the way in which we frame those conversations. 

Sophie: So you are gonna try and publish the, like needs assessment, I guess, of the Sugar Sisters? We do a lot of these projects, but a lot of the evidence doesn't actually come out around, you know, even those needs assessments. But even the, the evaluation, the outcomes of doing these community based and led programs. Is there anything that helps that happen? Do you think?

Gina: Look, I think it's probably the biggest gap I see, particularly within the remote setting. And I, I think it's really hard because you've got, you, you always hear about amazing work that's happening. And you're like, oh, I can't wait to read about that, or find out more about what they did. And you kind of never get that opportunity because things aren't really well recorded, whether that's because of staff turnover or you know, just red tape that might exist within an organization. I've been fortunate to have like a supportive supervisor and also an amazing research governance officer who's all for supporting evaluation and document, documenting the work that we do.

Sophie: How did you go with getting ethics? How was that process in the community space? 

Gina: The motivations behind getting ethics which was a really hairy process. It wasn't, it was lucky enough to have a project, not, it wasn't similar at all, but be able to look at an ethics application for another, for the remote stores work that we were doing because my goodness, they are huge process and also designing something that you think is gonna be culturally appropriate. I think if you are working in the community space it, it probably is good to seek collaboration with the university, with people who have more capacity and expertise in research.

Sophie: You know, if someone were to pursue like what you've done, which is they've got a project that they could easily just run, like you easily just could have taken the Sugar Sisters Project, you could run it. You don't need to get ethics approval, but it means that you won't be able to publish it in a peer review journal, which means people won't then be able to learn from your, like your work, and so then they have to redo that work in maybe a similar context, but start from scratch. How do you think or where, how do you think universities could potentially facilitate, give you some capacity within those projects when it comes to the things like ethics applications and, and research like methodology.

Gina: Oh, it's really a theme of the evening, but capacity building, I suppose. Just, you know, like this week I went and attended a workshop about writing for publication. I think it's really great to have that contact with, you know, an edit editor of a incredible Australian journal come and actually talk to people who are just really in the workforce and delivering programs. I think that's, you know, one element is providing those opportunities for people who are interested in research to, I suppose pathways to incorporate it into what you're already doing. Depending on your organization body sometimes you don't need ethics approval for all types of, I suppose, research if something's deemed as continuous quality improvement, you know, you still can publish that work externally. But the person who ran this session that I went to early in the week about writing for publication also mentioned. That sometimes journals will accept work along that line of continuous quality improvement, depending, obviously there's probably very strict protocols around it, and if you can justify why you didn't seek or need ethics, 

Sophie: It would be really good to have, like even as you're talking, I guess maybe some of my ideas from working in both. You know, spaces is like definitely having people actively engaging with community-based practitioners and, and talking about this is how we could support you. So we can, you know, maybe we can look at some of the work you're doing and assess is, assess if it's a CQI activity and then, you know, we can go, okay, and then these projects. We or these, even these elements of these projects, we will need ethics application to publish those. But let us do the ethics application for you. Like we will, we will lead the ethics application. You just need to give us like the [00:35:00] contextual information on the project, which is probably just in the project plan, and they can actually do that work and then even, you know, help facilitate the write up of that journal article. So just taking, I guess, the load off the practitioner and at the same time that's, that's capacity building in its own right, like being a part of that process. You will learn how to do an ethics application. You will learn how to publish a journal article. But you don't need to actually do that yourself. I think universities definitely have a role to play in, in doing that work and being know, able to do the work on stuff that is already being done. 

Gina: Absolutely. And I think like case in point is the work that we're doing with Store Scout, on Store Scout project, it, it is you know, collaboration with Monash University where they're the ones who are really leading the, the research. But then we as people on the ground with understanding of the. The unique challenges that we might face and, and also the people with the relationships, with the community stores are still having input into aspects of that study, you know, implementation and some of the resources we've view we have intended to use and I suppose that also, talks to my point about having research that is useful if you are collaborating with people who are literally on the ground delivering the services and getting feedback from them about what works and what doesn't work and, and the reasons why you are going to have a product like an end result that is way more relevant and useful for practitioners.

Sophie: For sure. And even I think on that, like it's, it's also allowing the community, like collectively, like across our nation, but even within those settings to lead the research agenda as well and actually produce research, like you say, that is relevant and is contextualized and appropriate and, and so much more useful to what, you know, people actually want to change within their communities. I do want to ask you cause I think other people might be interested in as, as well, the about the remote dietician network that you've established. 

Gina: So the remote dietician's network kind of came about in early 2021. And it started just with like a casual catch up with some dieticians that work in far north Queensland talking about a clinical case study kind of morphed into something a bit bigger where I thought this was really useful and it was such a nice feeling to have, you know, some of the struggles that I had been through with managing a complex case validated and to know that I'm not the only dietician out there feeling like this or, or dealing with these types of cases. Yeah, so then it became sort of like a opportunity for capacity building around clinical cases in the remote setting between you know, the, the team that I work in within Central Australia, another organization in Mount Isa, and one in Cairns provides a platform for networking, but also presents like clinical case studies. So you can kind of get feedback from, you know, a diverse range of dieticians with different experiences and also has a another side where we might present some of our community or public health nutrition work. And that kind of go is, is around the fact that a lot of organizations are doing really incredible programs, but we're just not seeing. That monitoring and evaluation or reporting happening. So rather than us like banging our heads against the wall and doing the same thing over and over again, we can. Hear what other people have done and what's worked. And then assess whether or not that could be something we could implement in our settings.

Sophie: And so if people are, cuz it's for the like, obviously it's for the remote dietetic space. If people are interested that aren't part of those organizations, are they able to connect in with like within to this network? 

Gina: Yeah, absolutely. I think we would be more than happy to yeah, open up the door to other organizations or dieticians. I think it's something that I am quite passionate about coming into the remote health workforce. As a new grad, I think you realize, Sometimes you do feel really alone. 

Sophie: Yeah, I think that'd be really useful for some people. What has been, I guess, your biggest learning along your career so far? 

Gina: I think specific to people who work with First Nations populations, I think one of the best pieces of, of advice I ever got was from my first manager in Broken Hill who told me that I'd never be culturally [00:40:00] confident. Quite a blunt statement but I think that really resonated with me and it's definitely something I carry like into my practice, is realizing that there's always something to learn. And just because I've done a cultural confidence in a cultural safety course by no means that, you know, I'm achieving, you know, a culturally safe standard. So I think it just makes me realize that, yeah, you should always be improving your practices and particularly the longer you've been working, cuz I suppose we can develop some unconscious biases. So we do need to be challenging those and reflecting on those constantly. 

Sophie: Definitely. I think that's a really, really good learning and something I hope a lot of people take a lot away from if they haven't already been exposed to that. I guess what then have been some of your proudest or most memorable moments? 

Gina: My favourite moments has been when I just like got out of the car and community once there was some little kids across the street who just yelled out my name and then ducked . Yeah, it was really cute cause they were trying to figure out if it was me and I think that they would've recognized me from some education sessions I'd done at the schools. And I think when you start to get that recognition within community, yeah, it's really fulfilling. That's, yeah. I suppose the, the best part of the work we do is the fact that we get, yeah, this privilege of working with an incredible. Well, people from an incredible culture 

Sophie: but also be exposed to some of the, you know, the knowledge and the learnings that come from working in that space as well. Thinking about the work that you've done, is there any kind of impact that you have seen as an outcome of the work that you do within these communities? 

Gina: I, I suppose some of the experiences I have had around own very small scale, and it might be, You've done a group education at the school and you know the kids have gone home and they've told, you know, the family about what they've learned or they've come into the clinic and they're telling the nurses. You know, seeing that engagement and knowledge passed on to young people is really exciting. From some of the, like one on one clients I have casually seeing what they buy from the shop and seeing that they have made some of those Swaps that you've recommended. Yeah, I think you are always gonna see short term or, or quite small scale impacts. You know, I think it will take years to. See more meaningful changes within health outcomes. 

Sophie: And think that's something that I, I think a lot of people struggle with. I know I definitely have had moments in the past where you wonder, what are we doing this for again? But you've really just got to believe in the process and, and know that, especially when things are evidence based, like, you know, you're talking about the Store Scout and even the Sugar Sisters program. And going, we, we know, like we've done the logic models, we've done, we've, we've got like things to base this off. We've just got to have faith that if we can put some really good, you know, things in there and, and it can be sustainable and engaging and, you know, community led and all those really key things we need for programs to work, then we will get outcomes. We just have to remember that we might not be the ones that see them. And is there anything that you'd like to see in the future of public health nutrition when you kind of look down the line of where we might be in 10, 20 years time? 

Gina: I definitely would like to see more work done in the advocacy space. You know, I think we all know that, you know, food has impacts on chronic disease management and prevention. But we also know that there are broader social determinants that are just as important. I would like to see public health nutrition really advocating for changes in more of that social context, whether that's housing, you know, so people have the opportunity to be able to safely store food. And I think you might have had some personal experiences with this from your food security. Like project, like where you, was it you were invited to like a transport working group or so something?

Sophie: Yes, I was. Yeah, cuz we identified that like, obviously people need to get to stores to access food. And so, and I yeah, worked quite collaboratively within the Alice Springs community and a few of the organizations put together a working group on improving the public transport within Alice Springs or, or, or looking at transport options. It might not have been just public transport, but potentially like buses that would go out to town camps and bring people into town. I think I, I remember just being like, I never would've thought that my, my job would lead me to working on a transport working group. But, but we did a need, a community needs assessment and that was definitely one of the bigger things. And also one of the spaces where we identified there was a gap in, in work being done. I, I do think that as dieticians and public health dieticians, we definitely need to continue to advocate or, and like you say, Do more advocacy in that space. Whether that's at a community level or at a [00:45:00] a state or national level. We can do so much more and, and our voice is very powerful. I don't think we realize. How powerful we can be, especially collectively.

Gina: I think when we're looking at, you know, that broader picture, we're moving away from that really reductionist approach to chronic conditions and obesity and really looking at more of a systems based approach. You know, I don't expect people to be changing their individual behaviour and choosing healthier options if they’re, you know, constant worry is when will they get food, not what they would be eating. So I think that, you know, you need to sort of fix those other social issues so that people can actually prioritize you know, healthy eating. 

Sophie: Yeah. That is a very stressful situation to be in and we really need to respect that we can actually be causing a lot more issues if we're trying to tell people to eat healthily when they might not either ever achieve that or they just can't prioritize that at this point in time. For so many different reasons, because, you know, you are quite early in your career. I am too. But I wanted to ask, do you have any advice for anyone wanting to start you know, they might have just graduated from university and a and a considering community or public health nutrition. Do you have any advice or tips as to how to maybe get into this area or what to consider from that point?

Gina: Go rural or remote? I think it is, you know, and I understand that that's not, that doesn't align with everyone's lives and priorities. But I think that the opportunities that are provided when you are working in a rural or remote setting are gonna help you develop a very diverse range of skills.

Sophie: Is there anything that you think people should look for when they are applying for jobs? Like if they want to build, you know, start a career in this path? 

Gina: Really considering like who you would be working with, like more in that leadership level. And I was fortunate enough to have met my team lead Amanda Hill when I did placement in Alice Springs. So briefly got to know her that was very impressed by her from the get-go and you know, really jumped at the opportunity to work with her. And if you are a new grad and you are sort of interested in learning more about remote nutrition and you know, that aspect, Public health within this context, still get in touch with us. You know, come along for a remote dietician's network meeting. You get the opportunity to really liaise with four different organizations. 

Sophie: And I hope that a lot of people do cuz I, I love it. I think you love it too. Thank you so much, Gina, for coming on the show and, and sharing with us so much insight into a space that not many people really get to experience or get exposed to within our field.

Gina: Thank you for having me, Sophie. It was a pleasure. 

Sophie: So thanks for listening. Remember, we're on Instagram and Twitter. If you'd like to get in touch, ask us any questions or even share with people you think might be interested. And if you do get the chance, please leave us a rating or review to help spread the word all about public health nutrition.