Strategic Directions

4 min read March 1, 2019 at 8:42pm

I'm currently on the plane on the way home from an out-of-session trip to Brisbane, where I've been at the Queensland AMR Strategy Roundtable. I must confess that I didn't have high expectations for the day, but I'll return to Cairns feeling very positive about the day, and about the way forward for antimicrobial stewardship in Queensland.

Those of you who have been paying attention will know I began work as the director of the Statewide Antimicrobial Stewardship program in November. It's work I'm very invested in; I've never really gone for those pop-psychology and popular-on-twitter diagrams of ikigai - but if ever I had one, this is it.

That's not to say, of course that it hasn't been without challenges. My appointment took an inordinately long time as there was some doubt that someone could live in Cairns and work in Brisbane (even despite the majority of our clinical work being done by telehealth). The program had been functionally without a director for a while before I started as my predecessor had taken a secondment somewhere else in addition to working another job, so was less available in the interim. This left the team with a direction but no guidance and nobody to carry the can. Underlying the acute uncertainty were some structural issues with the program's lines of reporting, which had been longstanding and had proved challenging to solve.

Trying to resolve the governance challenges was one of the first things I wanted to do when I started, but I was a bit stymied by the Christmas shutdown, and the Chief Health Officer's plan to hold a drug-resistance strategy summit, with broad representation from not only health, but other sectors as well. I was on the organising committee for this meeting, although I was a bit concerned that the timeline meant QSAMSPs would be spinning the wheels for another few months, but also that the invite list for the roundtable was more than a hundred people - surely at least 10 times the meeting size for making any decisions. Rebecca, the CHO's AMR project officer deserves great praise for being able to pull it all together.

I volunteered to give the opening keynote so I could try and not-so-subtly nudge the discussion to make sure rural and remote areas were front-and-centre in the attendees' minds.


My opening keynote at the Roundtable
My opening keynote at the roundtable(s) - with what has been described to me as a "very Trent slide" - Photo by Minyon Avent on twitter.

It's rather a challenge to give the state-of-play of drug resistance in Queensland to an audience consisting of experts much more experienced than I am, as well as vets, agriculturalists and biosecurity people who are much less familiar with the details of human health.

Especially if you have to do it in 15mins (I only ran over by 5min and Dr Allison Crook, the Chief Veterinary Officer was very kind to indulge me).

My key messages were:

  • Australia is a high-user of antibiotics (in human health)
  • Resistance is increasing
  • Things are worse in remote areas than in urban areas (more infections, more rapid increase in resistance and less access to healthcare)
  • Our response so far to drug resistance is based in the larger hospitals (sorry, again, Kathryn)
  • Our future response needs to be inclusive of regional Queenslanders as a critical issue of equity
  • Political will exists for this now, so we should do it once and do it right

I'm told that it came over fairly well, and I was very pleased to hear a number of people reference my calls for regional equity during the discussions in the remainder of the day.

So despite my scepticism about the size of the gathering, there was an excellent energy in the room, and I feel a strong commitment to turn talk into action. The wisdom of the room will be distilled into a draft strategy over the next couple of months. I've a feeling it's still a long way away from implementation, but at the moment, it's time to enjoy the feeling that there's a broad commitment to working on drug resistance in the community as well as in hospital.

I finished the day by relaxing in the airport lounge with one of the team, and we chewed the fat over where we'd like to take the program over the next few months. It's great to feel after months of "it depends on what happens on the 1st of March" that not only is our program doing good work, but that we can be fairly confident that it will continue in some form or another, and that more than likely we'll be even able to expand a little.

In the meantime, there's plenty left to keep us busy; we're enhancing our education program this year, building engagement with some of the health services we work with, and have plans to start getting some articles in press about the work we've done so far.

Thanks again to the team - they're a great bunch of people, and very nearly as passionate about this as I am.

Onward and upward for 2019!

Image credit: Jigsaw group meeting by Rawpixel via Unsplash - CC0