AMSA Rural Health Volume V Issue I 2020
Road to
Recovery
Road to Recovery Drought, Bushfires, Floods and now Viruses: How does this affect Rural Australia? 08 Road of Testimonies From droughts to floods in a flash 18 Road to Rural Health Future medic focused on bettering health for all 27
Contents Letter from the Editor
ELLI IZRAILOV 04
Meet the Team
FRONTIER! EDITORIAL TEAM 05
Letter from the Chair
SARAH CLARK 06
ROAD TO RECOVERY Drought, bushfires, floods and now viruses: How does this affect rural Australia?
BRIANNA WATTS 08
“We need our Country to be healthy so we can be healthy”
LORANE GABORIT 10
The likely mental health outcomes following the 2019-2020 ‘Black Summer’ bushfire season
ELLI IZRAILOV 12
Buy from the Bush
ISAAC WADE 14
Photograph by Andrew Baker Lord Howe Island New South Wales
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Contents
Photograph by Andrew Baker
Lord Howe Island New South Wales
ROAD OF TESTIMONIES Facing the fire(ing) lines
ADRIAN ARMITAGE 16
From droughts to floods in a flash LINDA SOUTER
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RACGP Rural Elective Bursary Report
BRITTANY HILL 20
ROAD TO RURAL HEALTH A Survivor’s Guide to Rural Health Events!
JASMINE DAVIS 23
Knowing you’re in the right place
NICOLETTE WARD 25
Future medic focused on bettering health for all
ELEANOR GREGORY 27
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Letter from the Editor Elli Izrailov Monash University (IV)
“Road to Recovery.” I wish I had come up with the title for this issue of Frontier! It’s concise, simple, to the point. Perfect. When I decided to return to the role of Publications Officer for AMSA Rural Health, I had a much better idea for what I wanted to do with Frontier!. For one thing, I wanted to expand the magazine from one annual issue to two per volume. For another, I wanted and I hope to disseminate the magazine to every rural clinical school site across the country. Finally, I wanted to continue the tradition of incorporating themes into each issue. In January when I was brainstorming as to what direction to take Issue I, my social media was flooded with news of what has come to be known as the Black Summer bushfires. I felt that given a magazine that
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revolves around rural health, it would be irresponsible not to discuss the farreaching consequences of this scarring event. And as I am editing this piece in March, it seems the title is ironically fitting in the present coronavirus scene permeating throughout the world. Which is why I would like to welcome you all to Frontier! – Road to Recovery, Issue I, Volume V, (whose title was thought up by Editor Peony Tan). We are, as always, exploring the rural health issues that matter to you with an emphasis on reviewing rural health in the post bushfire/flood landscape. In this issue, we have pieces discussing the health impacts for those
living in fire-affected areas, experiences of a former volunteer firefighter, testimonies from medical students working in flooded areas, and more. I hope that you will enjoy this issue that the editors and designers; Thedini, Kisal, Peony, and Bri, and myself have worked tirelessly to produce. It is a privilege to publish a magazine that has meaning, and one that has a strong presence in the current (changing) climate. Thank you again, and I hope you enjoy the reading. Kind regards, Elli Izrailov
The Frontier! Editorial Team
Brianna Watts Hi! I am a final year student at UNSW currently studying at the Wagga Wagga Campus. I’ve always been interested in rural health and in the last few years I’ve travelled to many towns in QLD, the NT, and NSW to see how health delivery services can be optimised for regional and rural communities in Australia. I joined Frontier! to discover other people’s rural healthcare stories and have been so lucky to work with an amazing and passionate team. I hope you enjoy the stories we’ve collected for this issue and I look forward to hearing about your experiences in rural Australia!
Kisal fonseka Hi readers, I’m Kisal, a final year student from UNSW. After several rural placements last year, I realized rural healthcare is something I’m interested in and would like to further explore. So when I saw the applications for Frontier! I decided to put my experience designing memes to good use and applied to help design this year’s issues of the magazine. Hope you enjoy reading this issue of Frontier!
Peony tan I am a final year student studying at UNSW. Being a city dweller for 23 years of my life, I recently had the chance to complete 3 months of clinical placements in Rural Australia, where I finally understood the hype around rural health. I decided to join the Frontier! editorial team as it was an exciting opportunity to continue to learn about the strengths and challenges of rural health. I hope you all enjoy this issue of Frontier, and happy reading!
thedini Pinidiyapathirage I am a first year student at Monash University and having lived in rural and regional Queensland for most of my life, I’m very passionate about rural health! As a preclinical student I thought that being a part of the Frontier! editorial team would be a great opportunity to stay involved and develop my love for rural health. Photograph by William Turner Bilgola Beach New South Wales
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REPORT FROM THE CHAIR Sarah Clark University of New South Wales (VI) Hi everyone! Sarah here, UNSW Wagga Wagga final year medical student, and AMSA Rural Health Chair for 2020. Welcome to 2020’s first edition of Frontier, ‘Road to Recovery’! Last year’s Frontier, ‘Rural is the Future’, was all about looking forward to the future of rural health. But I don’t think any of us could have predicted the turbulent start to that future that we’ve had! Between ravaging bushfires, devastating floods and now a viral pandemic, we haven’t really been able to catch a break so far in 2020. Our road to recovery has certainly been a bumpy one so far, and it could continue that way for a little while longer. The world is ever changing and in such tumultuous times we need to band together and look after each other. The rural way of life is often to face adversity with resilience and given the time and the resources, rural people will bounce back with a strength unlike any other. One day in a decade’s time we’ll all look back on this string of events and see how far we’ve come - and what a day that will be! So please - wash your hands, look after each other and seek support if coronavirus has got you down! Amidst all this turmoil, the world continues to turn and AMSA Rural Health will continue to represent all medical students with an interest in rural health, and keep you well informed about what’s happening in the rural health sphere. The current AMSA Rural Health Committee has only been around for a few months now, but we are already on the way to achieving a number of our goals for 2020. While some of our advocacy priorities
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continue on from previous years, such as Rural Clinical School Support and Bonded Medical Scheme reform, we also have a number of new advocacy priorities including promoting Rural Generalism and General Practice as a career, and Rural Elective Support. We also have a number of projects on the horizon, including a revamp of 2018/19’s Rural Student Support Report Card, and a rural internship spotlight to encourage students to go rural for internship. We’ve also made changes to how we operate to best serve the medical student community! We have a website of our own which is constantly being updated (www.amsarural.com), and we have decided to let go of our eNewsletter in favour of increasing our online engagement via our website and social media pages. But perhaps the most exciting element of change this year is the addition of ANOTHER issue of Frontier! Because you can never get too much rural health. I’d love to give a big shout out to Elli Izrailov, who has championed Frontier! for two years now and was the mastermind behind the extra edition of our magazine. Elli’s contribution to the 2019 edition of Frontier! was
amazing, and then he signed himself up again to make an already great magazine even better. I’d also like to thank his editorial team for their hard work in not only putting together one magazine, but committing to TWO publications this year. The next publication of Frontier is due to be released at Rural Health Summit, which will be held at Australia’s highest medical school: Armidale, NSW! Laura Mallett and Emma Deacon are doing a great job at coordinating AMSA’s primary rural health event of the year, and it’s shaping up to be a cracker, so make sure you keep your eye out for updates and we hope to see you there! If you made it to the end of this, well done! I know I hardly ever read the bits at the front of a magazine and just flip to the interesting content hidden inside. I hope you read the rest of Frontier! with enthusiasm and passion for rural health! If you have any suggestions for how AMSA Rural Health can better represent, connect or inform you, please don’t hesitate to get in touch with us via our social media pages (Facebook, Twitter or Instagram), or email rural@amsa.org.au.
ROAD TO RECOVERY Drought, Bushfires, Floods and now Viruses: How does this affect Rural Australia Brianna Watts
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“We need our Country to be healthy so we can be healthy” 10 Lorane Gaborit
The likely mental health outcomes following the ‘Black Summer’ bushfire season
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Buy from the Bush
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Elli Izrailov
Isaac Wade
Photograph by Daniel Knox Bell New South Wales
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Road to Recovery / Opinion
Photograph by Manuel Meurisse Grampians National Park Victoria
Drought, bushfires, floods and now viruses: how does this affect rural Australia? Brianna Watts University of New South Wales (VI) For many, rural life offers charm, a chance to get away from it all and a unique sense of community. However, it also comes with a cost, one which is well known by many rural Australians after a horrific summer that saw us battle through ongoing droughts, bushfires, floods and now a new threat facing the whole world; COVID-19. Whilst these events can exact a significant toll on both individuals and their wider communities, a common thread of unity can promote resilience and help us when the dust settles. Living in a rural area significantly increases the risk of experiencing one or more natural disasters; and in many small communities a state of emergency can persist for months and even years - placing a significant toll on the local community. Not only does a natural disaster pose the risk of
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“a common thread of unity can promote resilience and help us all to recover when the dust settles.�
potential loss of property, livelihoods and health, it also brings with it a myriad of long-term impacts that alter everyday life. This can range from road closures resulting in a physical barrier to shops, sports games and school; financial hardship due to loss and ongoing battles with insurance companies, as well as flow-on effects such as reduced retail spending and small business income in small town centres. The global threat posed by COVID-19 also threatens rural communities; a different type of ‘natural disaster’ if you will. Concerns regarding staff shortages, low numbers of ICU beds and a lack of ventilators are being considered by everyone; but are of particular importance in rural communities where there is already a significant shortage of GPs, nurses, specialist staff and other allied health workers. Furthermore, rural pharmacies have also started to feel the effects with reports of shortages of antibiotics and medications for chronic conditions running low in communities with an already high level of chronic disease burden. Whilst social distancing is a difficult adjustment for everyone, it can also compound the sense of isolation and loneliness felt by many in the bush, especially when the lifeblood of the community such as local events, sports groups and schools are no longer available as an opportunity to meet with your neighbour who “just lives down the road...” a few kilometres away. However, there are many steps that can and have already been made to try to alleviate the burden of these natural disasters and prepare rural communities for the
spread of COVID-19. The recent announcement of COVID-19 telehealth numbers was welcomed by ACCRM with a press release stating that “Having access to COVID-19 telehealth items on top of existing items supports rural General Practitioners provide video and telephone consultations to patients concerned they are infected with the disease.” Furthermore, the distance between big cities and rural communities can slow the spread of the disease from major centres like Sydney, allowing remote Australians more time to prepare. This ‘flattening of the curve’ can lead to a reduction in peak demand on rural and regional health services, as well as give communities time to implement measures to support each other. This will also allow better distribution of resources; including equipment and also medical personnel to the affected areas, as well as planning on transportation of patients to higher levels of care if required. Whilst still recovering from a tumultuous summer, rural communities need to continue to work together to prepare for COVID-19 and continue to work on adapting to the impact of natural disasters. In a small study interviewing participants from several towns in NSW, community cohesion and resilience were often discussed as ways that could help with the negative effects of natural disasters. Community groups and events sports teams, - they all offer support and promote community resilience and social capital to adapt to the impact of natural disasters. However, with current social distancing measures in place, rural communities still need to continue
their social connectedness through other means. To ensure ongoing support to these communities once the dust, ash, or floodwater have settled or even to help them prepare for new ‘natural disasters’, it is important for rural health professionals and government bodies to consider the long-term impact of these significant events, as well as look at ways to invest in and strengthen community bonds for already isolated members of our community.
References Davis, J. (2020). Coronavirus will test regional Australia’s already stretched healthcare system, experts say. Retrieved 14 March 2020, from https://www.abc. net.au/news/2020-03-14/coronavirus-to-test-regional-medical-preparedness-health-system/12046572 Morrissey, S., & Reser, J. (2007). Natural disasters, climate change and mental health considerations for rural Australia. Australian Journal Of Rural Health, 15(2), 120-125. doi: 10.1111/j.14401584.2007.00865.x New telehealth MBS numbers will immediately benefit rural and remote communities. (2020). Retrieved 14 March 2020, from https://www.acrrm.org.au/aboutus/news-events/media-releases/ article/2020/03/13/new-telehealth-mbs-numbers-will-immediately-benefit-rural-and-remote-communities Ng F, Wilson L, Veitch C. Climate adversity and resilience: the voice of rural Australia. Rural and Remote Health 2015; 15: 3071. Available: www.rrh.org.au/journal/ article/3071
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Road to Recovery / Opinion
Photograph by Andrew Baker Wauchope New South Wales
We need our Country “ to be healthy so we can be healthy.
“
Lorane Gaborit Australian National University (II) Understanding the unique experience of Aboriginal and Torres Strait Islander people affected by the 2019-2020 bushfires. Little more can be said about the physical devastation caused by the 2019-2020 bushfires than that which has already been said. With 18.6 million hectares of land burnt, 34 human lives lost, and an estimated up to 1 billion animals killed, for many of us just watching the news this summer was distressing (1). For local Aboriginal people, Traditional Owners and Custodians of Country along the New South Wales south coast and Victoria, even as the last fires were finally extinguished this month, the associated trauma and deep-reaching cultural loss is ongoing and immense. Yuin man, Warren Foster from Wallaga
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Lake, put it well when we he was quoted by the Guardian last December, saying: “The ancestors would be wild, I reckon, about what’s happened to the country, to our totem animals. There are hundreds of sites, male ceremony places, sites on our sacred mountain, that burned. Not only Yuin land but all over – there’d be thousands of places destroyed by these fires… We need our country to be healthy so we can be healthy. We need the animals. If that is all lost, our spirits die when they die.” (2). For Australia’s First Nations people, as defined by the 1989 National Aboriginal Health Strategy, health is “not just the physical well-being of an individual, but refers to the social, emotional, and cultural well-being of the whole community.”
This includes the well-being of Country, connection to spirit, spirituality and Ancestors, plant and animal life, family and friends (3).It is because of the central importance of Country and culture to health that the experience of Aboriginal peoples in the bushfires is different to that of non-Indigenous people. There are elements of grief, loss and trauma that are unique to the Indigenous lived experience. As Biamie Williamson, Jessica Weir and Vanessa Cavanagh explain:
Yorta Yorta man Neil Morris raised almost $1.9 million in just over a month (5), aiming to offer culturally sensitive, specific, and direct support to Aboriginal bushfire-affected communities (6). National recovery andrebuilding efforts should follow Morris’ approach, in initiating support for Indigenous people through a cultural and spiritual lens such as by supporting the recovery of cultural heritage sites, wildlife, and the provision of trauma informed mental healthcare.
“Colonial legacies of eradication, dispossession, assimilation and racism continue to impact the lived realities of Aboriginal peoples. Added to this is the widespread exclusion of our peoples from accessing and managing traditional homelands. These factors compound the trauma of these unprecedented fires.” (4)
For health professionals and medical students working in fire-affected areas, it is more important now than ever to engage with Aboriginal people in culturally sensitive ways, which prioritise self-determination. This includes thinking about Country, culture and community, and enabling local Aboriginal communities to adopt leadership roles, co-design health priorities, and implement Indigenous ways and means of healing. (7)
Aboriginal people are resilient and strong, and communities affected by the recent bushfires are no different. A Fire Relief Fund for First Nations Communities initiated and managed by
This article was written in partnership with AMSA Indigenous.
Note: Aboriginal people use the term “Country” to describe the geographical border of their communities land and all the natural resources, culture and history associated with it. AMSA Indigenous is a new AMSA special interest group, providing support and opportunities to Aboriginal and Torres Strait Islander medical students; and representing AMSA in Indigenous health advocacy, education and policy.
2. Allam, Lorena, ‘Grave fears held for hundreds of important NSW south coast Indigenous sites’, The Guardian, published online Jan 16 2020, accessed at <https:// www.theguardian.com/australia-news/2020/jan/15/grave-fearsheld-for-hundreds-of-importantnsw-south-coast-indigenous-sites>
Lorane is the 2020 Research and Publications Officer for AMSA Indigenous.
3. National Aboriginal Health Strategy Working Party 1989, National Aboriginal Health Strategy, CBR
References 1. Center for Disaster Philanthropy, ‘2019-2020 Australian Bushfires’, published online Feb 17 2020, accessed at <https://disasterphilanthropy.org/disaster/2019-australian-wildfires/>
4. Williamson, Bhiamie, Weir, Jessica & Cavenagh, Vanessa, Strength from perpetual grief, how Aboriginal people experience the bushfire crisis’, The Conversation, published online Jan 10 2020, accessed at <‘https://theconversation.com/strength-from-perpetual-grief-how-aboriginal-people-experience-the-bushfire-crisis-129448>
5. Fire Relief Fund First Nations Communities, Go Fund Me, accessed at <https://au.gofundme. com/f/fire-relief-fund-for-first-nations-communities> 6. Morris, Neil, Our Mother is hurting without us leading, IndigenousX, published online Jan 5 2020, accessed at <https://indigenousx.com.au/our-mother-is-hurting-without-us-leading/> 7. Secretariat of National Aboriginal and Islander Child Care (SNAICC), Triggering trauma: the impact of the bushfire crisis on Aboriginal and Torres Strait Islander Peoples, published online Jan 30 2020, accessed at <https://www.snaicc.org. au/triggering-trauma-the-impactof-the-bushfire-crisis-on-aboriginaland-torres-strait-islander-peoples/>
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Road to Recovery / Report
Photograph by Kevin Mitchell Newman Western Australia
The likely mental health outcomes following the 2019-2020 ‘Black Summer’ bushfire season Elli Izrailov Monash University (IV)
Introduction The 2019-2020 ‘Black Summer’ bushfire season represents an unprecedented bushfire catastrophe, the results of which will directly affect inner and outer regional communities for years to come.The latest figures show that the Black Summer bushfires have consumed approximately 18.6 million hectares of land, destroyed over 5,900 buildings, claimed the lives of 34 people, over one billion animals, and have driven some species to extinction (1,2). To compare it to other notorious bushfires that have scorched the country, the 2009 Black Saturday Bushfires took the lives of 173 people and over a million animals, burned through 450,000 hectares of land, and destroyed 3,500 buildings (3). The 1983 Ash Wednesday Bushfires saw 75 people dead and approximately 360,000 animals, with 520,000 hectares of land burned and 3,700 buildings destroyed (4).
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While in the short-term, bush-fire affected communities show resilience following natural disasters, the long-term outcomes are rife with psychological illnesses including post-traumatic stress disorder (PTSD) and depression (5,6,7). The numbers following this most recent fire season should be testimony enough that a wave of psychological outcomes will come crashing through the rural landscape in the next few months to few years. At present, no data is available, either by media or by government reports, determining the amount of people affected by the fires, with reports focusing on land burned, lives lost, and houses and buildings destroyed. The author undertook a preliminary evaluation to determine the number of people impacted by the fires to form an estimate of the likely amount of new cases of PTSD and depression associated with the ‘Black Summer’ bushfires.
Methods To determine the number of people affected by the fires, the area of land burned per state (2), was multiplied by the corresponding regional population density, as determined by population estimates and total area of those states (8). The calculations yielded an estimated population of 280,960 people who may have been directly affected by the Black Summer bushfires.
Results Modelling the results of a study by Bryant et al., 2014, which found that 15.6% and 12.9% of individuals from high-impact bushfire affected communities were likely to experience probable PTSD and depression respectively over a four year period (5), similar estimates indicate that 43,830 and 36,244 are likely to develop PTSD and depression respectively as a result of the Black Summer bushfire season.
Table 1. The estimated population of each state likely to be affected by bushfires.
State
Km2 of land burned
Population density* per Population effected km2
New South Wales
52,000
3
156,000
Queensland
25,000
1
25,000
South Australia
4,900
0.4
1,960
Victoria
14,000
7
98,000
Total
95,900
-
280,960
Discussion However, a certain degree of scepticism must be taken when viewing the results. On the one hand, these results could represent an underestimation. While the data was based on total area burned, many communities who evacuated their homes may have had their towns spared, meaning the number effected could be much higher. On the other hand, these results could be a gross overestimation, for example, 80% of the Blue Mountains World Heritage area (10,032km2) in NSW and 53% of the Gondwana world heritage rainforests in Queensland (3,700km2) were burned (9). These figures account for approximately a fifth of the area consumed in NSW and nearly a seventh of the fire-affected areas in Queensland, thus grossly overestimating population effected. The next few years may yield as many as 43,830 new cases of PTSD and 36,244 new cases of depression. Will rural and remote Australia be able to manage? In inner regional and outer regional Australia, there are approximately 6.4-4.9 psychiatrists respectively, and 61.4-46.2 psychologists respectively, for every 100,000 people, which is substantially lower
when compared to metropolitan based counterparts (16.2 psychiatrists per 100,000 and 105.3 psychologists per 100,000) (10). In order to tackle the likely rise of cases, more resources including personal and prevention strategies need to be in place for the rural space.
References 1. Burton J. ‘It was a line of fire coming at us’: South West firefighters return home. Busselton-Dunsborough Mail. 2020. 2. Noble F. Government set to revise total number of hectares destroyed during bushfire season to 17 million: Channel 9 News; 2020 [Available from: https://www.9news.com.au/national/ australian-bushfires-17-million-hectares-burnt-morethan-previously-thought/ b8249781-5c86-4167-b191b9f628bdd164. 3. NMA. Black Saturday bushfires: National Museum Australia; 2010 [Available from: https://www.nma.gov. au/defining-moments/resources/black-saturday-bushfires. 4. EMA. Hazards, Disasters and your Community. In: Attorney-General’s D, editor. 7 ed: Emergency Management Australia; 2006. p. 10-2. 5. Bryant RA, Waters E, Gibbs L, Gallagher HC, Patti-
son P, Lusher D, et al. Psychological outcomes following the Victorian Black Saturday bushfires. Aust N Z J Psychiatry. 2014;48(7):634-43. 6. Gibbs L, Waters E, Bryant RA, Pattison P, Lusher D, Harms L, et al. Beyond Bushfires: Community, Resilience and Recovery - a longitudinal mixed method study of the medium to long term impacts of bushfires on mental health and social connectedness. BMC Public Health. 2013;13:1036. 7. McFarlane A, Clayer J, Bookless C. Psychiatric morbidity following a natural disaster: An Australian bushfire. Social Psychiatry and Psychiatric Epidemiology. 1997;32(5):261-8. 8. Population Estimates by Local Government Area (ASGS 2016), 2006 to 2016 [Internet]. 2016 [cited 15/03/2020]. Available from: http://stat.data.abs. gov.au/Index.aspx?DataSetCode=ABS_ERP_LGA2016. 9. CDP. 2019-2020 Australian Bushfires: Centre for Disaster Philanthropy; 2020 [Available from: https://disasterphilanthropy.org/disaster/2019-australian-wildfires/. 10. AIHW. National Health Priority Areas. In: Welfare AIoHa, editor.: Australian Institute of Health and Welfare 2017.
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Road to Recovery / Opportunity
Buy From The Bush
Isaac Wade University of New England (III) Australia has gone through a nightmare these past six months, dealing with scorching droughts, catastrophic bushfires, merciless floods, and now CoVID-19. These natural disasters have, safe to say, had a colossal impact on rural communities and businesses, physically, mentally, and financially. To help out where we can, over the past few months we at AMSA Rural Health have used our social media pages to spread awareness of the dire situation by sharing the #buyfromthebush campaign!
The ‘Buy From the Bush’ campaign aims to connect rural businesses with city customers, and encourage people to invest in our remote communities, businesses and people. We’ve decided to showcase these three awesome rural businesses which we have shared over our social media and we hope that this will provide some inspiration for buying from the bush! For more companies showcased in the campaign, visit: https://www.buyfromthebush.com.au Isaac is the 2020 Promotions Officer for AMSA Rural Health. AMSA Rural Health received no incentives, monetary or otherwise to promote these businesses.
Country Culture Founded in 2012 with the goal of showcasing local Australian makers, designers and producers of beautiful quality items, Country Culture sells gift boxes of unique and exciting Australian goods. Founder Ange Lavender says “Country Culture started with my passion to showcase the unique artisan gifts I found in all areas of Australia, especially in hidden places such as country towns.” You can check out their full catalogue of goods at https://countryculture.com.au/
Faraway Gourmet Faraway Gourmet is a locally owned and operated gourmet food provedore based in Central West Queensland. “We love where we live and the people who live here, and want to bring a little something delicious to our community. We believe that lovely cheese, a fine wine and good friends makes for happy people and we hope to bring a little joy with every slice.” To order a fresh box of goodies, visit their website: www.farawaygourmet.com.au/
Iris and Wool Iris and Wool is a stylish knitwear label showcasing the journey from fibre to fashion, championing Australian Merino wool. “My brand iris + wool is a tribute to my mother who passed away when I was quite young. I do recall she adored Irises. It was only natural for me to combine the two loves in my life, ‘iris’ for my mother and ‘wool’ as an identity for the beautiful fibre.” Every iris + wool purchase makes a difference to Merino wool farmers and also supports the McGrath Foundation! Check them out at https://irisandwool.com/
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Photograph by Jasmine Elliott Warburton Victoria
Road of Testimonies Facing the fire(ing) lines!
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From droughts to floods in a flash
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RACGP Rural Elective Bursary Report
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Adrian Armitage Linda Souter Brittany Hill
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Road of Testimonies / Opinion
Facing the fire(ing) line! Adrian Armitage AMSA Executive Officer and Company Secretary A prospect that no one wants to face. Standing in front of a Fire(ing) Line. This term hit home in the recent fires impacting our Bush Capital (Canberra) and the surrounds. With a history of the 2003 fires
1.
destroying hundreds of homes still fresh in many memories the message of anxiety and fear of impending doom. The look on the faces of people talking to us at community engagement days in the South suburbs of Canberra conveyed the fear and mental anguish mothers
were feeling for their children and families. As volunteers working within communities, the objective has always been preparedness and also calming communities and ensuring there is a focus on planning and positive action. We all play our part in reassuring those we are
3.
2.
1. The fire line looming down on houses in the bush capital 2. Satellite image of fires approaching the southern suburbs of Canberra. 3. Volunteers for the ACT Rural Fire Service, SES and Community Fire Units in Canberra. Community preparedness days in Tuggeranong advising families on evacuation plans. Canberraâ&#x20AC;&#x2122;s Southern Suburbs.
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passionate about serving. AMSA epitomises this willingness to step up, indeed step in front of danger and shield many who cannot face the terror that confronts many people around the world at present. The spirit of volunteering has never been so strong as witnessed across Australian
Rural Communities where the willingness to hold the line and fight the fires was evident. People from all walks of life rolling sleeves up to help. This story does not end here, a dodged bullet for Canberraâ&#x20AC;&#x2122;s suburbs as the fires moved south east and impacted the small communities of Bredbo and Michelago. There is a sense of guilt as the survivors in Canberra look to the country communities of Batlow, Bega, Braidwood, Bombala, Nimmitabel, Adaminaby,
Khancoban and many more knowing that the road to both mental and financial recovery will take years. The story becomes personal with cousins living in Mallacoota living through blood red skies and a living Armageddon. The fear and prospect of impending doom was palpable, and facing the
prospect that loved ones could die in front of your eyes - real. The horror of local wildlife fleeing in terror and hurt with burns; all these images are life changing. My cousins were one of the lucky ones and they have opened their home to locals not so fortunate. The true challenge for all of us is supporting families who have lost properties, livestock, and cherished memories. These communities will need to be
resilient to face the devastation, with brave souls and strong hearts. Dealing with the associated anxiety knowing that drought and fires are taking on a new intensity in a world waking up to climate change is daunting yet unavoidable. Facing the fire(ing) line is just the beginning of a long ordeal
and it reminds all of us that our rural communities need doctors and health professionals for the future. To be there and help rebuild lives and communities in our beautiful country. The work ahead for AMSA Rural Health is never more important than over the next several years where we need to work closely with the Department of Health and other health centres to help survivors cope with the long-term effects of the fires.
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Road of Testimonies / Interview
From droughts to floods in a Flash Linda Souter James Cook University Communications Officer
When James Cook University medical graduate Dr Arvin Selvananthan headed off to his final year student rural placement at Winton in early 2019, he had no idea it would be a life-changing experience. Arriving in the small county town in outback Queensland, the Canadian student was confronted with a community that had been suffering the effects of drought for 15 years. “It was so dry and desolate.” However, things were about to change. “A few weeks into my placement it started to rain and you could see change in the community. People were really happy - the drought was well and truly over.” But the celebrations were short lived. With the rain continuing to bucket down, it wasn’t long before the area began to flood.
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“It went from depression from the drought, to elation, and then the realisation of the situation at hand.” “So many people lost their livelihood, millions of dollars worth of stock gone.” The small town became marooned from the outside world and it was all hands on deck to help out. “The majority of the news coverage centred on Townsville and there wasn’t as much attention being paid to the small country towns - that was pretty disheartening.” The two doctors at Winton Hospital, supported by Arvin, swung into action. “In a situation like this you are some of the only people there that can actually do something and who people will listen to.” “The farmers won’t leave their homes - that’s all they know. But they will come to see a doctor.” The biggest concern for the
medical team was the mental health of the community. There were a number of online resources delivered by Townsville psychologists and psychiatrists that guided the team on how best to deal with the situation. “We planned outreach programs for mental health screening as well as vaccinations.” “Early intervention for mental health is critical.” The team also delivered much needed supplies such as bread to the outlying properties. “It was quite an experience to see the community come together like that - everyone pitched in to help.” “I don’t know when you would ever get a 15-year drought and then a flood straight after again.” “It was a once in a lifetime experience.” The floods had a profound effect on Arvin and affirmed his view on the importance of rural medicine.
Photograph by Rebecca Hill Bundaberg Queensland
“Being a doctor in that town actually enables you to cause change and to provide services that people require.”
studying in Australia. I applied for JCU and got an interview. I then weighed up of all of my options and decided JCU was the best choice.”
Having grown up in Canada, life in a small county in Queensland was an eye opener for Arvin.
Moving to Australia on his own wasn’t a problem for Arvin.
“Everyone was lovely, some of the nicest people you would meet and they were always up for a chat.”
“To be honest the cultures are very similar. I get on with people and most people I met were of a similar age with similar interests.”
“I remember when I first arrived I went to the pharmacy and there was a car out the front with no one in it and the engine was running. You would never see that anywhere - you would think someone is going to steal this. But it’s just normal there. Everyone trusts everyone.”
Supporting him through his degree journey have been the staff of JCU.
“It’s like living with a sense of ease and peace, there is no need to worry.”
Throughout his degree, Arvin has had a range of placements that have provided real life experiences.
As an 18-year-old, Arvin wasn’t sure where he should study but decided on James Cook University and Australia offered unique opportunities. “Both my parents were doctors and one of their colleagues suggested
“They have been excellent. I have had multiple hurdles to jump over and some I didn’t make. They have been supportive the entire way.”
“I think the media portrays medicine as very intelligent, very logical, very ordered. For example, this is the disease and this is the treatment. But what I realised over time is that it is a lot deeper than that. You really have to get involved in a person’s
life. Even with all the information in the world, without being able to talk to a person, medicine doesn’t work.” “If you spend the time getting to know the patient you reap the rewards in the long run when they present again. You know their history and are able to pinpoint the cause. You see that a lot in rural medicine.” In the future Arvin is hoping to pursue the generalist pathway. “I have a lot of varied interests. I enjoy paediatrics, geriatrics and I am quite interested in chronic disease management and being able to correct that. Being a GP is like merging all of my interests together.” With his intern year at Mackay Base Hospital underway, Arvin said he made the right choice to head down under to study at JCU. “The experience at JCU is unparalleled. You see a part of the country and a type of medicine that you would not otherwise see.”
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Road of Testimonies / Elective Report
RACGP Rural Elective Bursary Report Brittany Hill University of New South Wales (VI) Most people who know me will be aware that I’m very passionate about rural health. However, having grown up in Coffs Harbour and completed some of my Brittany standing outside the Pine medical Creek Health Centre school training in Albury, most of my experience has been in major regional centres. Therefore, when it came time to start thinking about elective placements, I thought it was time to test myself. Just how rural could I go? I decided to spend four weeks in Katherine and an additional week in Pine Creek in the Northern Territory. Katherine has a population of approximately 6,300 and a hospital that serves an area the size of Victoria (as I was informed by local staff). Pine Creek is a remote town of just 320 people, about an hour away from Katherine. It doesn’t have a hospital, instead it has a clinic staffed by nurses and Aboriginal Health Workers, with doctors visiting a couple of times a week. Both Katherine and Pine Creek have a primarily Aboriginal population, with many people living more traditional lifestyles across various communities. There a few things that struck me during my time in Katherine and Pine Creek. Firstly, I was blown away by the experience and expertise of
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the health care staff I met during my placement. The nurses at Pine Creek had so many amazing stories to tell about their experiences working on cattle stations and in bush retrievals. Many of the doctors in Katherine are rural generalists, with additional training in areas such as anaesthetics and obstetrics. Some diagnostic facilities including MRI are unavailable in Katherine, so the staff must use their clinical expertise, phone consultations with other doctors and CareFlight transport to Darwin to ensure patient safety. I experienced a trauma case on one of my first nights in the Katherine Emergency Department, and the team of GPs, nurses and an emergency doctor stabilised a young boy before he was flown to Darwin. Unfortunately, I witnessed first-hand the poorer health outcomes in rural and remote areas, particularly amongst Aboriginal and Torres Strait Islander Australians. It was not uncommon to meet people in their 30s and 40s on who had a heart attack or were on dialysis for end stage kidney failure. This really highlighted the important role of the dedicated doctors, nurses and allied health staff I met during my placement. The traditional owners of the Katherine area are the Jawoyn, Dagoman and Wardaman peoples. I was able to learn more about their culture during a terrific training session run by Flinders University, who I organised my elective with. I then learnt so much more about this rich and enduring culture through meeting locals either at the hospital or in the community. Many patients don’t speak much English, and instead spoke one or more local languages. Therefore, medical ward rounds included an interpreter, who helped to address language barriers. Similarly, the Aboriginal Health Workers at the Pine Creek Clinic had an incredible understanding of the local families that
accompanied by a coach trip or drive at the end, limited accommodation options and a rising cost of grocery prices the further you get from a major centre.
Nitmulik (Katherine) Gorge, Northern Territory
greatly assisted their work. I also took time to explore the natural beauty of the Katherine region, including various hot and thermal springs and a guided tour of the Nitmulik Gorge (Katherine Gorge). Finally, I learnt that living in rural and remote Australia does not mean saying goodbye to your social life! The hospital staff were just so welcoming, explaining they understood how rural work can be isolating and invited me along to their Christmas parties and other events. I also lived with two other students and met people from different allied health degrees in the hospital. I was informed that there were many social sports teams that run during the year, but there were fewer options over the incredibly hot Territory wet season! I would like to thank AMSA and RACGP for their support for this elective. Rural electives do not come cheap, due to flights often
I can honestly say that my elective in Katherine and Pine Creek has confirmed that I would love to live and work in rural and remote Australia. As an aspiring rural GP, it was wonderful for me to see these different roles GPs can fulfil. I would wholeheartedly encourage anyone who is unsure if they would enjoy regional, rural, or remote medicine to also consider these options for their electives. You may find you love your experience as much as I did!
Brittany at Edith Falls in the Nitmulik National Park
Brittany was one of the five recipients of the RACGP x AMSA Rural Health Elective Bursaries for 2019.
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Road to Rural Health A Survivor’s Guide to Rural Health Events Jasmine Davis
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Knowing when you’re in the right place
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Future nedic focussed on bettering health for all
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Nicolette Ward
Eleanor Gregory
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Photograph by Andrew Baker
Lord Howe Island New South Wales
A Survivor’s Guide to Rural Health Events Jasmine Davis University of Melbourne (III) Why should I attend rural health events?
How do I access rural health events?
Yay! You’re reading this edition of Frontier!, which must mean in some shape or form you have an interest in rural health! One of the best ways you can explore your interest in rural health is through attending rural health focused events. Rural health events can take shape in many forms such as conferences, dinners, workshops, information evenings and online webinars.
Firstly, have a look at our website to see upcoming rural health events. Sign up to newsletters, follow the prominent rural health groups including ACRRM and RDAA on Facebook, alongside your state’s rural health association e.g. RDAV, RDAQ who will send out emails/posts when events are occurring.
Attending rural health events can help improve your understanding in rural training pathways, you can gain new practical skills and you may even gain a deeper appreciation for why rural health is such an important field of medicine. However, the greatest thing you can gain through attending rural health events is connections! The rural health family in Australia is large and diverse, yet you will find that similar students and doctors attend these events, and that you can gain such a great community of colleagues through attendance. Not only will these people become friends, they will become mentors, and people you will be able to gain advice on further down the track when you are making decisions on your rural health career.
If you find an event you are interested in attending, look at the relevant Facebook event or website to see registration options for students. Often fees are much lower for students, however it is often the case such events are still very expensive. Thus, if you are finding difficulty in financially attending these events, send the event organisers an email asking if there are any scholarship/ bursary opportunities! If there’s no luck there, contact your university’s rural health club and see if there are any bursary opportunities for you. When asking for financial support, always suggest something you can give back in return e.g. an article for publication or helping out as a volunteer during the event.
How can I make the most of the opportunity once I am there? Woohoo! You made it! You can make the most of your
opportunities firstly by preparing. Check out the conference/event program and highlight sessions that you’re super keen on attending. Read up on the speakers and see whom you’d like to approach for networking/mentorship. Come to the conference with goals of what you’d like to get out of it. This can be as simple as making a few friends, to as specific as - I want to meet a rural GP who will host me for a summer rural placement. Jot down a few points from each session of things you’d like to learn more about and take note of sessions that really move you... you may find your true passion at a rural health event!
How can I connect with other students/doctors at the conferences? Often larger events host student networking evenings combined with registrar/junior doctor events. Do your best to make it to these sessions and speak to as many people as you can. Remember: the rural health family is so welcoming, and all people want is to talk to someone who is kind, and who wants to help improve rural health in Australia. Join Twitter!! I cannot say it again, but Twitter is the #1 way to connect with other students and doctors during a conference. Find the hashtag
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Road to Rural Health / Opportunity
for the conference and express your thoughts on a session you’ve attended or share a photo with someone you met at the conference. Check out other people posting on the same hashtag and follow them! You’d be surprised at how many conversations start at conferences like “oh I think I follow you on twitter!”
The 2019 AMSA Rural Health Committee (RHC) at RHS 2019, Cairns
What can I do after the event? After the event, look back at the notes you’ve jotted down and read up on some things that interested you during the conference. Write a reflective piece about the conference to submit to Frontier or your local rural health group’s publication or newsletter. Express your gratitude to anyone who helped fund your experience and let the organisers know if you loved their event. And finally, get back onto our website and check out future events you can attend! Jasmine is the 2020 Events Officer for AMSA Rural Health
Left: Former AMSA RHC Members at AMSA NLDS 2019 Right: Participants at VRHC 2019
Jasmine Davis (third from right) at RMA 2019 providing a presentation with other students (including 2019 AMSA Rural Health Events Officer Brigid King, fourth from right) on the topic: “Students in Action”
“After the event, look back at the notes you’ve jotted down and read up on some things that interested you during the conference.” 24
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Knowing when you’re in the right place Nicolette Ward James Cook University Communications and Engagement Officer For Dr Carmon Guy, sharing her time between the local GP clinic and the hospital in the far north Queensland town of Cooktown provides not only a diversity of medical experiences but also an exceptional continuity of patient care with some bonuses thrown in the mix. “The medicine is really interesting when you do both roles, especially in a small community. I might have to manage a birth and then a road traffic accident at the hospital all the same day. Then the following day I’ll drive to an Aboriginal community to run a clinic,” said Dr Guy. “Working in the medical centre as well as the hospital you also get that continuity of care where you already know the patient and often their extended family because you are their GP. So when they present at the hospital in an emergency, you’re able to give much more holistic support and care to the patient and their family.” “And the thanks you get is incredible. Getting some home-grown organic tomatoes dropped off to you
because you’ve cared for someone in the emergency department is always a nice affirmation that you’re in the right place.” Before moving to Cooktown and completing her GP training, Dr Guy spent four years at Cairns hospital where she completed her advanced skills training in paediatrics and obstetrics. Having this training helped to play a role in the re-opening of the birthing facility at Cooktown hospital, which has since had a significant impact on the wellbeing of the community. “The women don’t have to travel to Cairns and leave town for up to six weeks while waiting for the birth of their child. By staying in the community, they can have their family around them, and also have the same midwife assist them throughout the entirety of their pregnancy.” Having a birth in the hospital also creates wellbeing for the staff according to Dr Guy. “It creates a really lovely vibe throughout the whole hospital, it affects all the staff, when there is a birth here. The team environment and community atmosphere are really strong here.” Dr Guy also works as a part-time medical educator with JCU, supervising medical students from JCU in their fourth and sixth-year FRONTIER!
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Road to Rural Health / Interview placements, and helps to support registrars in country towns throughout Australia. “Working in Cooktown has really enhanced my career,” Dr Guy said. For Dr Guy and her family, living in the Far North Queensland region provides for some fantastic ways to spend their downtime, with fishing at the top of the list. “We spend a lot of time fishing out on the reef in our boat, or if it’s too windy or rough we go fishing in the creeks and go crabbing. There are also lots of sailing boats on the Endeavour River and we’re planning to learn how to sail.” For those not keen on fishing, there are many opportunities to get involved in other activities. “It’s one of those communities that are extremely welcoming. There are certainly no barriers to finding an area of interest. There are lots of people with different interests, whether it’s camping and hiking, arts and crafts, yoga, or sports like tennis and even underwater hockey. I’ve found over the years, whether it’s a medical student or a doctor, that they always tend to find something to do that they’re interested in.” “Living and working in a community like Cooktown affords you so many personal and professional opportunities if you’re willing to take the chance.”
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Photograph by Elijah Katranski Barossa Valley South Australia
Future medic focused on bettering health for all Eleanor Gregory James Cook University Communications and Engagement Officer For most year ten students from metropolitan Melbourne, an exchange program to Arnhem Land would be an eye-opener at the very least. For JCU medical student Isabelle Nehme it proved the driver that would see her pursue a career in medicine with a focus on health systems and improving care and equity for those in need. “I was one of a small group of girls selected for the exchange. We stayed with an Indigenous community for a month, which whilst incredibly eye-opening, was also quite raw and confronting,” Isabelle said.
in health stemmed from being on the receiving end of care. “From a very young age, members of my family and I had chronic conditions. While I believe medicine in Australia has great acute care, I think sometimes we are still finding our feet when it comes to treating patients with chronic conditions and all the factors and barriers that come with that.” “I realised I was passionate about systems, access to care, and how each stakeholder interacts with the healthcare system. I found myself increasingly aware of what good doctors looked like, and what types of interactions and care felt truly patient-centered. That has motivated me with my study.”
“I felt so helpless that it drove me to want to do something about it. I couldn’t ignore the systemic factors that shaped daily life for the locals there. I felt that given my interest in health this was something I could work to address.”
Fast forward half a dozen years and Isabelle is well on her way to achieving her goals. With a passion for rural and remote health, she enrolled in Medicine at James Cook University where she has just completed the fourth year of the program and her first of a Master’s degree in Public Health majoring in Health Economics.
Coming from a non-medical family background, Isabelle said her initial interest
Her passion for health systems has also seen her represent Australia at the United Nations FRONTIER!
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Road to Rural Health / Interview realising I didn’t have to be a big shot to make a difference. I just needed to know how to push action and practicality. Age wouldn’t prevent me from holding others to account; from being able to bring many groups of people with different interests but a unifying mission together and move them forward to action.”
Universal Health Coverage Multi-stakeholder hearing in New York. “I had been a lead author for a policy paper on universal health coverage inwhich we’d set out calls to action that we wanted other stakeholders to work on. But after the policy passed, I felt like I was no longer moving the needle on its calls to action. I wanted to interact directly with the issue’s key decision-makers and be at the forefront of discussion.” With its aim of developing universal health coverage, the United Nations hearing gave Isabelle the perfect opportunity to do just that. “It was eye-opening. Amongst a room filled with global leaders, we were one of just two groups representing the voices of young people. I walked in thinking I was a nobody. I wasn’t a 65-year-old CEO with weight to my name. I walked out of the experience
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Not one to rest on her laurels, Isabelle is continuing her work in health policy and advocacy, taking on an executive role with the Australian Medical Students’ Association as Vice President External for 2020. “It’s humbling focusing on future doctors’ advocacy priorities and representing the voices of over 17 thousand Australian medical students. It aligns with my values and where I want to go moving forward.” “I have begun travelling to Parliament to meet with MPs and other state and national medical bodies and departments. I’ll be continuing to discuss a range of central priorities for medical students, including mental health and wellbeing, international student rights, the intersection of health and climate change, and the challenges facing Indigenous and rural and remote students.” As part of the role,
Isabelle said she will canvas the thousands of medical students around the country to ensure their priority concerns are being addressed. For the first time that will also include climate change and its impact on health. “This hasn’t been raised as a national priority impacting students before. It shows how climate change is emerging as a major concern for us.” She said the increase in participation by JCU students on the national stage in teams and leadership roles has also been extremely positive, with local students increasingly drawing attention to the issues of rural, remote and Indigenous health. With her agenda busily filling for the coming year, Isabelle is excited about the future, working to help improve health care and health equity for all.
CONTRIBUTORS EDITOR IN CHIEF Elli Izrailov
FRONTIER! EDITORIAL TEAM Brianna Watts Kisal Fonseka Peony Tan Thedini Pinidiyapathirage
AUTHORS AND PHOTOGRAPHERS Adrian Armitage Andrew Baker Britanny Hill Elijah Katranski Eleanor Gregory Isaac Wade Jasmine Davis Kevin Mitchell Linda Souter Lorane Gaborit Manuel Meurisse Nicolette Ward Rebecca Hill Sarah Clark
SPECIAL THANKS TO
Kevin Mitchell for this issueâ&#x20AC;&#x2122;s beautiful front cover Cody Derbyshire, Elijah Katranski, Melinda Sobel, and Sarah Clark for providing valuable suggestions and advice in shaping this issue of Frontier! The content of this magazine is from individual members and does not necessarily reflect the views of the entire AMSA organisation
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ON BEHALF OF THE FRONTIER! EDITORIAL TEAM AND THE ENTIRE AMSA RURAL HEALTH COMMITTEE - THANK YOU FOR READING
Volume V Issue I 2020
Road to Recovery