Pandemics in New South Wales prisons: the more things change .

BACKGROUND: The current COVID-19 pandemic is not the first time New South Wales prisons have faced contagion. This paper examines the current responses in New South Wales prisons to the threat of COVID-19 to prisoner health, by contrasting contemporary activities with actions and policy developed during two historical epidemics: the influenza epidemic of 1860 and pandemic of 1919. METHOD: Epidemiological information relating to cases of disease in NSW prisons during the 1860 and 1919 influenza epidemics was obtained from the Comptroller-General's reports for the specific outbreak years and for the preceding and succeeding five-year periods. Additional archival sources such as digitised newspaper reports and articles available through the National Library of Australia were analysed for closer detail. The management of these outbreaks was compared to current strategies to mitigate against risk from the COVID-19 pandemic in the NSW prison system. RESULTS: Interesting similarities were discovered in relation to the management of the historic influenza outbreaks in NSW prisons and in the management of the current COVID-19 pandemic. An outbreak of influenza in mid-1860 impacted seven penal institutions in Sydney and Parramatta. Infection rates at these institutions were between 3.1% and 100%; the mean rate was 41.8%. The public health measures employed at the time included allowing 'air circulation freely night and day', and treatments that were 'tonical and stimulatory'. DISCUSSION: While the past 100 or more years have brought huge progress in scientific knowledge, public health approaches remain the mainstay of outbreak management in prisons; and, as in 1919, the opportunity for Australia to observe the rest of the world and plan for action has not been wasted. Prisons pose a potential risk for pandemic spread but they also present a unique opportunity for reducing disease risk by ironic virtue of the 'separate system' that was recognised even 100 years ago as characteristic of these institutions.

Medical student well-being during rural clinical placement: A cross-sectional national survey.

CONTEXT: Understanding rural student well-being is essential to inform the development and training of the future rural medical workforce so as to ensure a pipeline of rural doctors to meet rural communities' needs. However, little is known about the well-being of students who are on rural placement. This study aims to identify the predictors of well-being amongst a national sample of medical students on rural clinical placement. METHODS: The Federation of Rural Australian Medical Educators (FRAME) 2015 national exit survey of medical students, completed at the end of rural terms, was used (n = 644) to test the associations between well-being and demographic, financial, academic, supervisor, placement and clinical skills factors, and attitude to future rural work. Univariate and logistic regression were used. RESULTS: Students aged 18-24 years (odds ratio [OR], 8.07 [95% confidence interval {CI}, 2.07-31.46]) and 25-34 years (OR, 4.06 [95% CI, 1.35-12.18]) reported higher levels of well-being compared to students aged over 35 years. Academic support from the rural clinical school (OR, 5.74 [95% CI, 2.59-12.73]), perceived respect from supervisors (OR, 3.13 [95% CI, 1.23-7.99]), not feeling socially isolated (OR, 2.7 [95% CI, 1.40-5.20]), access to counselling services (OR, 2.05 [95% CI, 1.10-3.83]), rural placement being a first choice (OR, 3.04 [95% CI, 1.58-5.86]) and positive attitudes to being part of a rural workforce in the future (OR, 4.0 [95% CI, 2.0-8.3]) were associated with higher odds of well-being compared to students who felt the opposite. Gender, rural background, financial support, clinical skills and role clarity were not found to be associated with well-being (P > .5). CONCLUSIONS: This study may provide guidance to rural clinical schools, policymakers and medical educators in developing rural placement programmes that enhance student well-being so we can address workforce shortages in rural areas.

Health behind bars: can exploring the history of prison health systems impact future policy?

The value of history is, indeed, not scientific but moral … it prepares us to live more humanely in the present, and to meet rather than to foretell, the future - Carl Becker. Becker's quote reminds us of the importance of revealing and understanding historical practices in order to influence actions in the future. There are compelling reasons for uncovering this history, in particular to better inform government policy makers and health advocates, and to address the impacts of growing community expectations to 'make the punishment fit the crime'.

Finding a Space for Women: The British Medical Association and Women Doctors in Australia, 1880-1939.

This paper examines the experiences of women in one professional organisation - the British Medical Association in Australia - during a significant period in the development of such bodies. In doing so it offers an opportunity to consider the relationship between professional societies and the construction of a gendered profession. For the medical profession in particular the time-frame of this study, from the 1880s to the 1930s, has been regarded by scholars as especially important. In this period various features of medical professionalism came to prominence: the status and authority of doctors, the processes of formally registering medical credentials, and the scope and cohesiveness of professional associations. Taking the third of these themes, the current paper extends previous analyses by uniting gender with history and medicine as the central point of examination, in order to evaluate the changing and contested positions of women within the profession. In this way we not only demonstrate how the history of professional societies can reveal the diverse beliefs and shifting priorities of their members, but also contribute to explaining the remarkable persistence of gendered differences in the medical profession.

Disability and mammography screening: intangible barriers to participation.

PURPOSE: The aim of this study was to investigate intangible or non-physical barriers to participation of women with disability in mammography screening. METHOD: Women with disability were recruited via specific advocacy and support organisations in New South Wales, Australia. Interviews were conducted which focused on issues relating to participants' experience with breast screening services. RESULTS: A total of 75 women with varying degrees of disability agreed to participate. Three key intangible barriers were identified related to the women's expectations to be informed, to be involved and to be treated with respect. Details of the content, type, timing of appropriately presented information as well as who should provide it were emphasised. Barriers to active involvement to manage their disability and take control over their experience were identified. The women also indicated the specific treatment they received from screening staff which negatively impacted on their experience. CONCLUSIONS: This study has provided important and clinically significant detail of intangible barriers to participation in screening mammography experienced by women with physical disability. These study outcomes suggest ways in which the satisfaction with the mammogram experience can be increased for these women and contribute to increased participation in mammography screening.

Idealists or pragmatists? Progressives and separatists among Australian medical women, 1900-1940.

Histories of Australian medical women have long relied on timeless narratives of valiant "pioneers" battling opponents among the "male profession". The not-so-embedded implications of progress-through-struggle seemed well-suited to a settler society. This article challenges that approach by examining the foundation and development of the Rachel Forster Hospital, a Sydney hospital created in the aftermath of the First World War, and staffed exclusively by women. The article argues that medical history, and particularly the history of women in medicine, needs to be cautious of such well-worn notions as the "male dominance" of medicine, and the assumption that medical practitioners shared a common outlook. I insist, moreover, that separatist medical women and their institutions must be seen in the context of their society, by demonstrating how the choices they made and the reactions they provoked reflected their time and place. The success of the Rachel Forster during the interwar years illustrates the crucial role played by interactions between medical considerations and wider issues of public policy. Sensitivity to the prevailing intellectual and political debates is important in understanding the actions and motivations of medical women in any period.