Family genogram

Introduction to family and community

This part provides a series of case studies of an Australian family with a Mediterranean/European background who had a history of cardiac conditions. The family consists of 3 generations who live together: Maria and her husband Maximo, their son John, and John’s daughter Elisabeth. Maria and Maximo migrated from Italy to Australia almost 50 years ago as newlyweds to Corndale, a small village outside Lismore. John and Elisabeth are first and second generation Australian. Unfortunately, Elisabeth lost her mother 5 years ago due to breast cancer. Maria and Maximo also have a daughter named Sofia, who lives interstate.

This part illustrates the complexities that can arise within families who live with chronic cardiac conditions and present with multiple risk factors. This part showcases health promotion strategies and details how to navigate the Australian healthcare system. The part starts with a section outlining the family’s background, its medical and surgical history and associated risk factors. This is followed by 3 case studies: 1) heart failure diagnosis and management; 2) myocardial infarction and an escalation to coronary artery bypass grafting surgery; and 3) cardiac risk factors and health promotion strategies.

The Rossi family

Maria and Maximo Rossi

Maria and Maximo met in the Italian town of Agugliano near the seaside city of Ancona. They were married just prior to emigrating to Australia in their mid-20s. They started their married lives on a dairy cattle farm in the northern New South Wales (NSW) village of Corndale, just outside of the city of Lismore. Maximo had existing contacts locally when they first arrived, with an uncle, aunt and 2 young cousins already residing on another farm in the area. Like many in Australia, the northern rivers of NSW region boasts a proud heritage of Italian immigrant families. Maria and Maximo have been lifetime members of the Italo-Australian Club in Lismore, where they have grown strong connections and relationships with other local Italian and Australian families over the decades.

Maria and Maximo grew up in the Catholic faith and have continued to observe Catholic traditions and practices within the Parish of Saint Carthage’s Cathedral in Lismore. Between their local farming community, the Italo-Australian club and the Saint Carthage’s Parish, the Rossi’s have lived a life surrounded by an extended and supportive community. Maria and Maximo gained Australian citizenship several decades ago and are very proud ‘Italian Australians’, enthusiastically embracing both cultures as their own.

About 6 months after moving to Australia, Maria was delighted to discover she was pregnant with their first child. Their first-born child was a daughter, whom they called Sofia. Their second child, a son named John, came along 2 years later. Maria and Maximo would have dearly loved to have had many more children, but unfortunately Maria suffered complications and several miscarriages following John’s birth and underwent a hysterectomy in her early 30s.

Maria is now 75 years old after migrating to Australia with her new husband Maximo (now 77 years old) at the age of 25. While English is her second language, she has a very good grasp of both spoken and written English. Maria’s closest friends would describe her as kind, generous, clever, and a fantastic cook with a great sense of humour. Maria spent many years working part-time as a carer for the elderly retired nuns from the Catholic Presentation Convent of the Sisters, who resided in Presentation House behind Saint Carthage’s Cathedral. When Sofia and John attended school, the cathedral was right next door. They would love to come and visit the elderly Sisters after school and meet their ‘mamma’ Maria.

Along with her husband Maximo, Maria is a farmer, not just a farmer’s wife! She has always fulfilled farming duties, from milking cows, feeding the cattle, moving cattle to higher ground when it floods, to ensuring water troughs are filled during the dry times. She used to be responsible for the farming books and records but was more than happy when John took over that job many years ago after his studies, moving it all onto the computer! Maria was fascinated by the computer when it landed in the home office all those years ago and has developed her own skills; from playing games of solitaire in the early days, to googling for facts and, more recently, online shopping. In this way she is quite unlike her husband Maximo, who has never taken to the digitisation of the world around him. To this day he maintains a handwritten journal of weather and rainfall from the first year they moved to the farm in Corndale . Maria and Maximo have taken a step back from managing the farm, and are enjoying this new chapter of looking after their health and ageing together.

Sofia Rossi

When Sofia grew up, she studied law at Southern Cross University in Lismore, before taking a job interstate in Queensland. She met her husband Ben through her work and moved to Melbourne with him when their 2 children (Samuel and Alexandra) were still very young. She is now 49 and has a wonderfully fulfilling life and career in Melbourne, where she has lived for over 20 years. She travels home to visit her family on the farm 2 to 3 times a year.

John Rossi

John, now a 47-year-old male, grew up and studied agricultural science at the University of New England in Armidale, NSW, before returning to his family farm to live with his parents after the loss of his wife 5 years ago. He currently works locally as an agricultural scientist with the Department of Primary Industries of NSW (DPI). John chose this career specifically so he could support his parents and continue the legacy of the farm they have established.

When he was 27 years old, John married his wife Jenna in a beautiful ceremony at St Carthage’s Cathedral. He and Jenna renovated and extended the original Corndale farmhouse, which enabled them to live comfortably and privately on the same property as Maria and Maximo. Jenna adored her in-laws and was a very much-loved part of the Rossi family. John and Jenna welcomed their only daughter Elisabeth in the first year of marriage, before encountering a period of fertility difficulties. When Elisabeth was 6 years old, her mother was diagnosed with breast cancer. Following surgery, several years of treatment, a period of remission and a cancer relapse, Jenna succumbed to the disease 8 years after her initial diagnosis when her daughter was 14 years old.

John has been the main carer for his daughter Elisabeth and has raised her on the Corndale farm with the support of his mum and dad. He also manages the running of the farm with the support of his now elderly father Maximo. He is not only passionate about farming, but also a hardworking and caring man who gives back to the community that helped his parents establish a life in Corndale.

Recently, John has been feeling stressed and overwhelmed from years of looking after his daughter and helping out on the land . He has not taken time to grieve and has tried to continue to live his life as normal. In the last 2 months, John has been experiencing health problems, significant weight loss and a desire to be alone. His family now feel very concerned as he is managing his health alongside his job with the DPI and the farm.

Elisabeth Rossi

Elisabeth is now 19 years old and has very recently started studying to become a primary school teacher at the local Southern Cross University campus in Lismore. She is your quintessential Australian 19-year-old, who loves the beach, social media, and hanging out with her friends. Her dream is to live and work in Italy for a year or 2 after she completes her studies. She has been working on her Italian language skills with her nonna and nonno Maria and Maximo. Despite her Italian heritage, Elisabeth grew up in a primarily English-speaking household.