Question :

Scenario 1

Ben

1. Ben is a 28-year-old male who has recently returned to Westtown after serving 10 years in the Australian Defence Force (ADF). Ben grew up on a farm in the Westtown area and returned to the region to be close to family and to seek employment in the mining sector. Ben was working on the local mine however having only been employed for 6 months was one of the first to be laid-off during recent workforce downsizing. Ben has been unable to find employment in town due to the economic downturn associated with the ongoing drought in the area. As a result, Ben has had to move back to the family farm with his parents. The farm is located 25km from Westtown and the nearest neighbors are 5km away.

2. Ben returned to the care of his childhood GP when he returned to Westtown with whom he has a good rapport. Ben visits the clinic monthly for psychological consultation for post-traumatic stress disorder (PTSD) associated with is military service. This is paid for by the Department of Veterans Affairs (DVA). Before returning home Ben's tasks in the Defence Force were primarily office-based following a training accident 3 years ago which resulted in an Lumbar 4 - 5 spinal fusion and associated medical restrictions resulting from chronic lower back pain. Ben was forced to leave the ADF on medical grounds 9 months ago.

3. Ben receives assistance with medical costs from DVA for both his Post Traumatic Stress Disorder ( PTSD) and back injury. Before his accident, Ben had a very active role in the ADF as an infantry soldier and felt frustrated by the restricted duties due to his injuries. He says he would rather ‘work with his hands’ than ‘drive a desk’. Ben has been attending the Youbeaut clinic regularly since he commenced work at the mine as the increased physical nature of work in this environment has exacerbated his lower back pain.

4. Ben is used to having a close network of friends and has enjoyed living in town. In particular, socialising with old friends and with the younger members of the Fly in FLY out (FIFO) mining workforce.

Scenario 2

Jessica and Nel

1. Jessica is a 17-year-old female who currently lives with her grandmother Nel (aged 57). Nel is Jessica’s primary carer. Nel’s husband died at the age of 45 in a motor vehicle accident and there are no other family members at home. 

2. Jessica has lived with her grandmother since age 10 and is about to enter her final year of high school. Jessica and her grandmother are Aboriginal. Nel is an active member of the large Aboriginal and Torres Strait Islander (ABTSI) Community where she is a community elder.

Nel

1. Nel was born and raised in Westtown and has lived in the area all of her life. Nel’s children have grown and left home. Her daughter (Jessica’s mother) lives 200km away and only has periodic contact with Nel and Jessica. Nel’s two sons and their families live in Westtown.

2. Nel has remained relatively healthy in later years although she does have rheumatoid arthritis and a 40-year history of smoking. She has recently been diagnosed with COPD (emphysema).  In the last few years, Nel has been finding it increasingly difficult to juggle work, family and social commitments due to her medical issues.

3. Nel has worked as an Aboriginal Health Worker for twenty years both in community health and at the  Aboriginal Community Controlled Health Services (ACCHS) and she has a high level of health literacy. Nel is passionate about the delivery of culturally appropriate health care in Western NSW.

4. Nel reduced her hours to part-time when Jessica came to live with her and she is concerned about what her recent deterioration in health status (including COPD diagnosis) will mean for her work and ability to care for Jessica.

5. Nel is finding it challenging to escort Jessica to Sydney to the cardiac specialist and to other specialist appointments such as her biannual paediatric reviews 200Km away.

6. Nel is also increasingly relying on Jessica for assistance with her activities of daily living (ADLs),  managing her medication, and jobs around the house. She is becoming frustrated with her decreasing ability to perform these activities and the resulting decreased engagement with the local  (Aboriginal and Torres Straight Islander (ABTSI) community due to her medical and functional restrictions.

7. Although she has a large number of family and friends in the Westtown area, Nel is determined to maintain her independence and is reluctant to rely on others for assistance. Nel is also concerned about what will happen to Jessica is she is seen to be not coping at home.

Jessica

a. Jessica has long QT syndrome which is treated with medication and an internal cardiac defibrillator (ICD). Her condition has been well managed since her move to Westtown to live with Nel due to social issues at home. 

b. Jessica finds her heart condition restrictive particularly due to the physical restrictions (sport is the main social activity on weekends) and constant requirement to travel for medical appointments. 

c. Jessica has received counseling for anxiety and depression in the past and also struggles to maintain a healthy weight (BMI 30) which leads to some social issues at school.

d. Jessica came to live with Nel due to issues with her care at home 10 years ago. These issues related to difficulties dealing with social issues at home and her ongoing need for specialist cardiac care.

e. Jessica is very happy living with Nel particularly being part of the extended family and social community. That said, the last few years have become challenging for Jessica with increased social pressures and workload at school as well as Nel’s deteriorating health at home.