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Rural Road to Health

Apr 20, 2024

Melanie Hartmann is a healthcare worker with a bachelor degree in interdisciplinary healthcare and management from Germany. She has been reseaching primary care netwroks on the Halligen Islands.  She talks about the unique way in which primary care has been organized on the Halligen and the insights that she has gained during her research.  

Episode summary:

00.55  Melanie tells us about her professional background and how she got involved in rural health

02.50  How is primary care organized on the Halligen Islands?

06.20  What are the characteristics of the community?

09.10  What are the different roles of nurses on the Halligen?

11.30  How do nurses reach the people on the smaller islands?

13.30  What are the challenges to access healthcare?

16.15  What challenges do the nurses face working on the Halligen?

19.55  Melanie talks about the research that she has been doing about primary care on the Halligen

25.00  How does local identity impact the provision of healthcare?

27.00  How does local culture and identity affect healthcare workers that are coming to work in these communities?

29.00  Top three tips for people thinking about a rural health career


Key messages:

There are no doctors based on the Halligen, they visit once every two weeks.  Nurses lead the primary care on the Halligen for a population of about 300 people. 

In summer there are a lot of tourists, this is important when considering the healthcare that is needed during the summer months.  The population can more than double. 

In winter fewer ferry connections to the mainland than in the summer.  

Nurses are the most important interface between primary and secondary care, they are parts of the community.  They rotate every 2 weeks on the larger islands and they are present on the island 24/7.  

First aid responders (members of the local community) exist on the smaller islands and they have some limited equipment available and provide basic emergency care while waiting for further help to arrive. 

Leaving your home to receive healthcare requires a great deal of effort, personal and cognitive resources - not everyone has these.  

The community on the Halligen were the first community to be fully vaccinated for COVID-19 as the nursing team knows the community and where everyone lives.

Nurses that work on the Halligen are highly trained.  They are all emergency nurses and have developed further skills on the job. 

How can networks help to secure healthcare and how can they make healthcare better?

On the Halligen the importance of community nursing is on full display.  

Local identities are important, there are those that have lived there for a long time and those that have recently moved there.  This results in very different expectations from healthcare. 

Every community has its own identity.  You have to find a shared goal with the community.

It is important to have a good understanding of the local environment and the social determinants of health that impact on the community and individuals. 

Top 3 tips: 1) Look at and understand the community identity on site as you are often an outsider.  2)  Develop trust. 3) Prioritize goals which connect with the identity of the community.


Thank you for listening to the Rural Road to Health!

Rural Health Compass - Navigating Rural Health and Policy