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TABLE OF CONTENTS EDITOR’S FOREWORD Linna Huang CAREER, CARE, AND COFFEE Kira Muller “Dating in medicine is easy, but it is also so difficult.” YOUTH NEURO AUSTRALIA - An Interview Michele Fu with Jade and Onur; founders of Youth Neuro Australia CLINICAL COUTURE Jennifer Peng How to make the hospital corridors your runway IF NOT MEDICINE Elli Izrailov “If not Medicine, I’d be a writer.” GORDI / DR SOPHIE PAYTEN - An Interview Linna Huang IN HINDSIGHT Tilly Robertson A poem MY INTROVERT DAYS, GIT TROUBLES AND THE HUNGER GAMES Yashaswini Makkoth “Do you know where the lavatory is?” I AM Yangzirui Fu A poem DR DEBORAH BATESON - An Interview AMSA Sexual and Reproductive Health FROM THE PRESIDENT Jessica Yang
Editor’s foreword Linna Huang AMSA National Publications and Design Officer University of New England/Newcastle Year IV Thanks for picking up this issue of AMSA Panacea - AMSA’s biannual magazine. This issue’s theme was “Pursuing Passion”. In this issue you’ll read incredible interview features with medical student organisation founders Jade and Onur, musician/ doctor Gordi, and Professor Deborah Bateson; as well as an array of incredible student submissions on varying topics such as dating within medicine, and how to pull off that clinical fashion in hospital. Thank you to you all the students who submitted pieces to this issue. If you think you would be interested in submitting something to next year’s Panacea, reach out to our incoming Publications and Design Officer, Michele Fu and the 2020 Publications team at pdo@amsa.org.au. Happy holidays!
Acknowledgements EDITOR-IN-CHIEF Linna Huang (UNE) PUBLICATIONS TEAM Sarah Broome, Editor (Monash) Hayley Fancourt, Editor (ANU) Wai Chung Tse, Writer (Monash) Michele Fu, Writer (UNSW) Neha Vetnani, Digital Artist (Griffith) FRONT COVER freepik: “Door graphic”
SPONSORSHIP OFFICERS Cai Fong (UQ) John Shenoda (Bond) WITH SUPPORT FROM
Career, Care, And Coffee
Being in medicine also means I am constantly surrounded by engaging, intelligent, and captivating people. The hunger to learn more and more, consistent self-reflection and perpetual growth, and the willingness of provocative exploration of life philosophy, morality, and mortality are traits common of people in the medical profession. They’re also personality traits I find indisputably sexy.
I am a social butterfly. I love making new friends, I love spending time with old friends, and I love By Kira Muller (James Cook University; Year III) dating. Coffee, brunch, parties, picnics, cooking, bars, art galleries, drives to the beach, perusing Dating in medicine is easy, but it is also so bookstores. I love it all. And I especially love difficult. doing it with fascinating new people. Don’t get me wrong, I love medicine. I feel like I was built, born, and bred to work in the healthcare space. I’m one of those weird people who actually enjoys pathology, and I can’t wait to have it as an entire subject alongside my clinical classes for the whole of next year. I enjoy my own career hustle and feel incredible reward from studying medicine. I entered the medical field because of my love for people and the positive emotional impacts quality healthcare can have on entire families. But sometimes, to paraphrase a quote from a Hawkeye Reis song, all the interesting stories in medicine over and over again can get very boring. My passion and drive pull me through in these moments, but only just. I often need to do activities that remind me why I am passionate about medicine in the first place. A reminder that the late nights spent writing assignments or going through hundreds of Anki cards in a single sitting will all be worth it for a higher goal – practicing as a doctor.
“Yes, I can grab coffee with you, but I have a whole bunch of work due this week, and I have two assessments next week, and I have AMSA council 3 that weekend where I’m presenting, and the weekend after that I have Rural Health Summit, then I have to catch up on study, but definitely after that!” I wholeheartedly apologise to the person I said this to a few weeks ago. I didn’t realise how ridiculous I sounded until after the words had passed my lips into the abyss. At least I managed to leave out trying to manage time with my family, local friends, long distance friendships, my dog (for whom I recognise myself as the centre of his world), and whatever forms of self-care I can fit in between the rest of that. I thankfully didn’t burden you with a rant encompassing all the content of my life’s to-do lists. We should not live to work – we should work to live. Valuing quality of life should not be limited to our patients and should extend to ourselves. We value patients surrounding themselves with their
family and loved ones during their journey in the healthcare system. We highlight the benefits of human connection on positive mental health, yet we often neglect our own social needs in pursuit of our careers. And then when I manage to find time to go on dates (trust me, even I am surprised), they wildly vary in quality. When I do find someone that I am fond of, they are painfully similar to myself; workaholic, nomadic, intense, night owl, coldly logical, and most definitely overcommitted. These aren’t traits that are conducive to healthy romances. I haven’t even scraped the surface yet of how complex dating another person within the medical sphere is. On the wards, overthinking and hyper-analysing the possible pathologies is a good thing and can protect the patient from complications and poor outcomes. But medical students and junior doctors have a hard time switching off this mentality when they enter high-stakes social spheres, where their own emotions are on the line instead of the patient. Dissecting every social action, diagnosing where every potential interpersonal relationship issue may arise, and scrutinising our casual dates in the way we scrutinise an ABG for imbalances. I have noticed, in my own experience (and with acknowledgement of my own hypocrisy), that we often forget that humans are inherently flawed social beings that make errors in words, judgement, and actions. Medical students are the most picky, exclusive, and selective in the dating scene. Medical students also hate to admit being incorrect, which can translate to poor conflict resolution in relationships. In many cases, we can be analytical creatures to our own detriment, and we can be unforgiving of people not falling in our predefined social and personal ideal “normal reference ranges”. My mother works at my local public hospital, and we frequently used to joke when I was younger that doctors always end up marrying other doctors. But now, as a medical student, I totally understand it. It’s almost strange now when someone in my course tells me that their partner isn’t a medical student or a JMO. Dating another medical professional is complex, but working out the logistics of dating someone who has no first-hand experience on what a hectic lifestyle
pursuing a medical career entails is a higherlevel challenge. My passion is a personal strength; it drives my hard work in all my academic endeavours, and it drives my personal values in the way I treat the people I care about. My passion and energy are, on the surface, assets in my social and dating life. But when you examine more closely, my passion leads me to feel very isolated in my career pursuits and my social life. A lot of people who share similar interests with me, and have a compatible personality with mine, tend to study medicine on the other side of the country. If I was them, I wouldn’t date someone either who can often only fit in online dates between the hours of 10pm and 2am either. Bummer. Additional to loneliness, I struggle to find time to care for myself. Hobbies are few and far between. I downloaded Audible purely because I felt like I hadn’t read a single book all the way through during my time in medical school. I love writing poetry, but most of mine now is barely coherent from being formulated at 2am in the morning, the only time I allow myself to not feel guilty for indulging in unproductive written work. I have been meaning to draft a book for years. It has always been my dream to have a children’s book published. The way that books in my childhood inspired me to learn about the world and other peoples’ perspectives was magical and nourished much of my personal growth. I have notebooks scattered through my house filled with brainstormed notes for a future novel – dot points to pages scrawled at all hours of the evening. I fear the difficulty of balancing this dream with my medical career will result in it never coming to fruition. This terrifies me.
We have all heard the phrase “you can’t love someone else if you don’t love yourself.” Pursuing passions outside of our careers with no incentive except emotional rewards for our souls is an important form of self-care. This is part of the pyramidion of Maslow’s Hierarchy of Needs, integral to self-actualisation and leading a fulfilled life. As I get more neck deep in my medical career, I am struggling to find time to effectively practice self-care. If I can barely ever find time to take myself out for avocado on toast and a warm soy mocha, how am I meant to find time to entertain a romantic interest in similar activities? Contrary to this drive for my career, I have moments of longing for a simple life. I want to do laps of the swimming pool on the beach front on every odd morning for an hour or so, mindless arms over shoulders and tumble turns. I want to meditate, paint, write, nap, and cook whenever I feel inclined to. I want to invest time into following my romantic passions and build trust with the right person. Someone to share a dog with. Someone stable to hold my hand when I need it. But how can I do that properly while focussing the bulk of my energy and time on my career?
tolerate my long study hours, high-stress lifestyle, nor how I speak in a concoction of medical lingo and acronyms. You don’t notice it until a nonmedicine person points it out to you. Finding a schedule of another medical student that lines up with my own availabilities is like shooting clay pigeons – I actually managed to hit one once on a shooting range, but I’m pretty sure it was just luck. Something a non-med ex-partner said has stuck with me, “Kira, you just need to make more time for us.” I recognise that in comparison to homogenous non-med relationships, I probably wasn’t spending much time with my partner. But from my perspective, I felt like I was spending every spare moment with them between studying, classes, assessments, meetings, and trying to manage a baseline level of self-care. I gave all the time that I had around my medical career pursuits, and it still wasn’t anywhere near enough. I cannot juggle my career and romantic pursuits in a way that emotionally satisfies me on both fronts. Or at least, to remain hopeful, I haven’t figured out how to do it yet. What is actually more important; that I dissect and memorise every square inch of the human body, or that I take a submarine into the depths of a beautiful person’s soul? Will I really find more happiness in climbing the consultant career ladder? Or am I better off investing my time into the people around me that I care about?
Everyone wishes to be close to someone who has the highest level of understanding of the inner workings of their soul. If I can barely find time to casually date, I am unsure how I am meant to meet a prospective long-term partner in all this medical career mess. I don’t know if anybody outside of the medical space will My sinuses are clogged with the smell of formaldehyde and hand sanitiser, and I long for the sweet scent of orchids. Maybe a vanilla caramel candle, or some fancy bath soaps.
Interview by Michele Fu (Left) with Jade Pham and Onur Tanglay (Top and Bottom Right respectively) from Young Neuro Australia It is a truth universally acknowledged that studying Medicine, or any other full-time degree at that, is an energy-sapping commitment that limits one’s opportunities to pursue interests outside of their curriculum. In my experience, I’ve found job-hunting to be much more challenging than I envisioned, without mentioning the painstaking tasks of scheduling in social events and keeping up to date with my Instagram stories. Nonetheless, if you search hard enough within your cohort, you will find peers who manage to pursue something magical outside of Medicine (and still pass their assessments). Today, I am fortunate enough to interview Jade (UNSW III) and Onur (UNSW II), who I believe can change the world of research for young people. In 2018, Jade and Onur founded Youth Neuro Australia (YNA), a not-for-profit organisation which seeks to provide workshops, mentorship, online resources and state-wide education programs tailored to high school students, whilst also developing other upskilling workshops, networking events and volunteer opportunities for those in university. Although the organisation is still in its early stages, YNA has already gained the support of the Brain Foundation, the Australasian Neuroscience Society, Neuroscience Research Australia (NeuRA), the Florey Institute of Neuroscience and Mental Health, the Australian and New Zealand Brain Bee Challenge (ANZBBC) and the NSW Department of Education and Training. Thank you Jade and Onur for agreeing to participate in this interview. Starting a not-for-profit organisation when you are barely out of high school is a formidable task. Why did you make the decision to pursue this and what were your main drivers? O: I have always had an interest in education and learning, in terms of both the psychology behind it and the practicality of it. Having experienced the gaps which exist in STEM education, I wanted to
address these somehow and as someone who loves to bite off more than they can chew, I knew I would not be satisfied by doing this at a personal level. I was also very aware of how likely we were to fail and how unrealistic these goals were - but I obviously had nothing better to do with my time so there was no harm in trying. Initially it was all very neuroscience focused because of both of our involvement in the Brain Bee and that is how Jade and I met and decided to launch YNA. We were then and still are dissatisfied by the level of neuroscience education at the high school level and this passion was a big motivator at that point. We were both aware that the issue was accessibility, both to the complexity of ideas and resources needed to contextualise them but it was very challenging to sell this very niche field to a large audience. Through lots of trial and error and hours of discussion it became clear that we could make a more of an impact by providing skills rather than knowledge. We are now working to provide access to skills that young people can apply within their everyday lives and use beyond school: things like critical thinking, problem solving, creativity and communication. Neuroscience became our vehicle to deliver this and we integrate it into our workshops to continue to raise awareness but more importantly to make our programs individualised and student-centric. We want to create a positive learning environment that draws on neuroscience to empower people to find and pursue their passions. J: Applying for medical school was not the achievement or sense of success I was looking for, and what instead struck me was my privilege in arriving at where I was: a place comfortable and supportive enough to give back and apply what I have learned and gained throughout my life. I developed an inclination towards action, towards the concept of ‘passion projects’, of smaller attempts to use and share all of this enthusiasm I built up in a practical and meaningful way. At the time, my mind shifted back to a particular representative at the ANZBBC, who told me that
he was absolutely fascinated by neuroscience, yet expected nothing more with the limited resources and support he had back at home. So here was the new concept: home. A national home with issues of disparity and a very Australian-esque issue of disperse resources and accessibility issues beyond key metropolitan areas. STEMM communities felt lacking or shortterm at most. Was there really anything that united the achievements discovered in high school versus the re-attempts one has to make in university? Anyone to be available to guide us? It’s almost equally as universal: university is a chance to start again, as it is a place where you have responsibility for yourself, and where you are almost always on your own. If you are lucky enough to enter the medical pathway, it’s all set for you. So make your move. Shift things. Cause commotion. It is a very millennial way of thinking, to believe that you have the capacity to incite change - but you can. We get taught about “taking small steps” to “make a big difference” but rarely do we get a chance to take the reins. We’ve taught neuroscience to high school students all the way out in Armidale and even discovered the almost completely under-supported vein of homeschooled students. We’ve had health awareness campaigns that had us receive gratitude from people across the country and internationally. For Onur and myself, our passion for neuroscience is a vehicle to shift the culture of STEMM education; to make it all about learning again, about critical thinking and innovation and building a sense of national community. Our job is not to make people fall in love with neuroscience, or medicine and/or research in particular; we wanted to teach others how to integrate passion in the fields you explore, or the learning you attempt. It was back to basics for us - how to learn for the sake of learning and how to truly apply the skills you learn. I believe that time spent in university encourages young people to find out more about the world they live in and consequently strengthen their views and interests. At the same time, there exists a disparity between ambition and realistic capability. What steps did you take to begin your not-for-profit? O: This disparity often confronts us but the three strategies we always go back to are patience,
adaptability and setting achievable short and long term goals that pave the way for more ambitious ideas. This is all on a background of teamwork and communication, which is how it all started - four people on a video call discussing how the vision Jade and I had could become reality. We were then hit with about 12 months of business plans, fulfilling legal requirements, finding sponsors and picking colour themes for our brand. These collectively make up the wall that stands between idea and fruition that comes to be referred to as “logistics” and most of the time we are trying to get around it. Aside from us becoming more proficient at this, it has been immensely valuable to surround ourselves with a great team of people. Jade and I can at times get carried away so it is important that we have people who tell us to pare things back. We have also been fortunate enough to form multiple partnerships with whom we collaborate as much as possible to combine forces and tackle a common cause. J: To add to that, our self-belief was our critical first-step; we believed in the process and our way of thinking, while also being humble enough to not expect instant satisfaction or even long-term success. We were lucky to have shared the same drive and aspiration for YNA to become a reality, and indeed involved a lot of planning, discussing, collaborating and problem-solving. (Surprisingly fun.) What were the biggest challenges about starting a STEM-centred not-for-profit as a medical student? J: Despite our inherently STEM-focused backgrounds and interests, it can mostly seem irrelevant to be passionate about the culture of STEM education and what it means in the context of Australia. Unfortunately, this is also on top of us having to investigate a tricky field with absent traditional qualifications, especially in social entrepreneurship, and not being too well-off financially, as a startup not-for-profit. O: Convincing people to believe in our mission when we often had very little belief in ourselves was very difficult, especially in our first year. As medical students coming out of high school we also were foreign to the world of business and choosing to be an independent organisation meant that there would be no one to offer advice or guidance. We had to learn everything ourselves
and continue doing so. Of course, the setbacks tend to be disheartening when you have put in so much time and effort, but it is all a learning curve and we continue to fine-tune and improve. At this point in time, what does YNA mean to you? J: YNA was and continues to be an excuse for me to do what I always wanted to do: to teach others neuroscience and neuroanatomy. To share my excitement for “all things ‘the brain’”, to give others the same opportunities and privilege I had to get to where I am today. To be creative and to challenge convention. To show others how cool scientific research is! To remind others that medicine is the application of science; an intersection and union between science, arts, humanity, and technology. To embrace life and a love of learning, that has done me so well over these many years. And to share, how in time, you learn that everything you do develops you as a person, and gives you skills and appreciation in so many departments. For instance, who would’ve thought that you could appreciate the maths and physics of art and creativity? (Actually, I can answer that for you: da Vinci. I absolutely revere da Vinci.) O: YNA is first and foremost a way for me to share my passion with others and hopefully inspire them in a meaningful way. The responsibility I have over it offers a great amount of freedom to take risks and try new things, which I find very exciting. Beyond this though, I see YNA as a series of creative and personal challenges which have helped me grow. There is no denying that I am a control freak. YNA has allowed me to (wait for it) control this and put it to good use. I have learnt to embrace the chaos of managing a large team and be flexible in times of crisis. YNA presents so much potential and opportunity that I hope we can harness. I think ultimately, it will become, much like a first child, the benchmark which sets the tone for my future endeavours and against which I judge my successes and failures.
/youthneuroAU @youthneuroaustralia yna.org.au
Let’s address the elephant in the room. Starting a not-for-profit is no easy feat, but even an elephant could tell that accomplishing that whilst studying Medicine would be exceptionally challenging. How did you organise this in amongst your studies?
‘straightforward’ as medicine. I have personally been on an ongoing battle with this because I want to do so, so much. And it’s not traditional. You’re expected to graduate as fast as you can, squeeze out your internship and residency, (and maybe a masters? PhD? Or a family?) and then hop onto traineeship and hopefully become a J: It was and still is a struggle. I’m not an incredibly fellow with some financial security before your organised person, so I surprise myself by my life ticks away before you. But it does. And time ability to manage what I do, but never have I becomes your resource. ever perceived that studying medicine, nor a fulltime degree, would be a huge hindrance to doing Unfortunately, there are always reasons for something like starting YNA. There’s a lot I do us to be held back, but we need to be kind to give to myself regarding drive and determination; ourselves, and permit yourself to explore and you need to put in the effort to expect something enjoy said passions. However, there’s also the back. And always start small. I think it’s purely (somewhat) dangerous idea that “you can have it this self-belief in capability - but, of course, I’m all”, which is even more of a struggle as a female only human. I do succumb to pre-event or pre- -- but by having it all, it’s always compromised: pitch anxieties, or neglect self-care and personal you sacrifice from each commitment. wellbeing, but it’s a learning curve that I definitely don’t regret. My advice is to be smart. Be appreciative. Take care of yourself first; be in a place where you can O: It is still a frequent occurrence to find Jade fall back to support, or can support yourself. But and I having online breakdowns at 2am as we be smart about what you do. In medical school, discuss where we are heading but we have you have more time to play around with your embraced these challenges and get through passions and interests now, and I would very them by communicating. There being two of much encourage that. You have the resilience and us is also a great comfort as we are able to space to live and to learn. You have room to fail, tag-in and out if we have other things going on. and to come back with a renewed perspective. Running a start-up as a full-time student, while Finding and/or pursuing your passion is just also juggling research and work still remains a a fragment of the process of maturation, and challenge though and has taught me a lot about it does take time. Explore. Innovate. Cave into the importance of time-management. I love lists curiosity. This is your playing field; you’ll head in and try to dedicate all my attention to one task at the right direction soon enough. We’re so young a time. I often complain though that there aren’t now. And for those who need to hear it: life is enough hours in a day, so anyone who knows me more than medicine. will at least know that I consume a lot of caffeine and don’t sleep a lot. I do try to balance this by O: I’ve been very lucky in this regard but I know eating well, exercising and meditating. I wouldn’t that many do struggle with it. In my experience have it any other way though. though, knowing what you are passionate about is not exactly going to make life easier, so, not What advice would you offer to medical students knowing is okay. Not knowing is a part of life. It who are itching to find their passion or pursue it will be easier to find your passion when you’re not but haven’t been able to because of their degree? putting all that pressure on yourself. There are some things you can do to develop yourself and J: Passion can be a fickle concept; it is mistaken find some things you like doing. I do hope for the to presume that you have to find your passion sake of society and the individual that medicine is now, or that you are in the wrong for not pursuing a passion, because it is certainly more than a job it beyond the best of your abilities. But it is equally and one you will be better at if you do love it. At mistaken to presume that you become limited to the same time though, it is crucial to not let that your career, or that you have to follow traditional consume us and try to maintain a personality. pathways and notions of success, and such is It is perfectly okay to be involved in things that particularly an issue when it comes to a path as are irrelevant to medicine. Try as many things as
possible while you have time to do so and when you find something you like, continue doing it. Develop new skills, learn a new language, pickup a new hobby - challenge yourself to grow as a person. Ask yourself what you already love or read about or even what others around you do. The more exposure you have, the more likely you are to find what you like. Then just try. Reserve some time every week to try something new, and if you find yourself procrastinating, then perhaps there is a reason you don’t want to do that - so then try something else. Finally if medicine is in the way of pursuing your passions, see if you can fit it in along with your studies or find smaller steps you can take now to work towards a bigger goal later on in your life. Where do you see yourselves in five years’ time? J: Life is unpredictable and volatile and exhilarating all at once, and five years ago, I would have never pictured where I’d be today. Regardless, I always aspired to be my best self, and I hope that amongst all the dreams and goals I have, that I do find quiet amongst my registrar years, and that I don’t stray from my values and priorities. I want to continue humanitarian work beyond medicine. I want to keep writing and learning and photographing, and all of my sporting endeavours (and to have mastered sourdough). And I hope that I still have the determination and energy to do all the projects I have such passions about, to make the most out of my life. I just don’t ever want to forget that I can do things, but I have to also remember that there is a time and place for everything; it’s humbling to stop and watch the clouds drift by. O: I try to focus as much as possible on the present because life tends to be very unpredictable but I do have some general goals. I will hopefully be at the end of my internship, so I am guessing I will have less time than I do now. Once that year passes though, I don’t want medicine to be the only thing I do, so hope to be involved in other projects that interest me, whether that is in science, social impact or business. Interview by Michele Fu; with Youth Neuro Australia Founders: Jade Pham and Onur Tanglay
CLINICAL COUTURE Appearances matter in medicine – on first glance we need to seem professional, trustworthy and capable in front of our patients and supervisors – and what we wear plays an important role in these initial impressions. However, contrary to every medical tv show ever, clinical wear is not as simple as a set of blue scrubs and a white coat anymore. How we dress today is a reflection of a diverse generation of medical professionals who live in a contemporary society that celebrates individualism, innovation and sustainability. “Here’s hoping that I blend into the patient’s curtain”
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Generally speaking, clinical wear is a less formal version of classic business workwear. Tight pencil skirts and blazers are impractical for running after JMOs and registrars. 7.
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1/ Uniqlo EZY Ankle Pants 2/ Witchery Elbow Sleeve Crew Top 3/ Status Anxiety Plunder Bag 4/ Littmann Stethoscope Classic III 5/ Forever New Eden Linen Blend Pencil Skirt 6/ KeepCup Brew Cork 7/ R.M. Williams Adelaide Boot. Other graphics from Pinterest
“I’m a fun medical student! How cute is Gorman? Gorman Gorman Gorman.” 2. I love Gorman, but patterns on patterns is basically a crime against fashion. Pair those new Gorman pants with a plain shirt, please.
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Stay mindful while shopping. Help the environment and your wallet by popping into your local charity shop, where you’ll often find preloved (or new) threads from quality workwear brands such as Country Road and Saba. 1/ Witchery Crew Ruffle Sleeve Top 2/ J. Burrows A4 Storage Clipboard 3/ Happy Socks Faded Diamond Socks 4/ Fjällräven Kånken 5/ Rollie Derby Shoes 6/ Gorman Holly Cardigan 7/ Frank Green Ceramic Reusable Cup 8/ Cotton On So Me Scrunchie 9/ Gorman Uncover Upswing Pant. Other graphics from Pinterest.
If not Medicine?... If not Medicine?...
by Elli Izrailov
Monash (III)
If not Medicine I’d be a writer. There’s no special reason behind it. I’ve loved reading from a young age, and I’ve always fantasised about writing novels. I remember, I may have been in the Third Grade, our teacher told us to write a story and it had to be a page long. Me being me, I wrote an ‘epic adventure’ of a knight and a wizard saving princesses spanning some five pages. And if that’s not a reflection of my failure to be concise I don’t know what is. But you can’t REALLY make a career of being a writer. My parents told me it’s a nice hobby but that’s about it. They were delighted by how avidly I read, sneaking a flashlight into my room and staying up way past my bedtime, but they also emphasised the importance of getting a good education to be successful. It would have been in the Sixth Grade that I became fixated on becoming a doctor. Maybe this pursuit to prestige was because I had something to prove, or that I found being a doctor awfully romantic, or maybe it was the closest thing to being a superhero. Regardless, high school for me was focused on trying to get into Medicine, and I worked my ass off (with varying degrees of success). But as Medicine became my focus, writing took its place at the back of my bookshelf. Something I’d fantasised about, something I thought I could be alright in, but something I told myself I’d get to in the infinite ‘later’. But then I didn’t get into Medicine after high school. I was devastated. What did I do wrong? I’d smashed the UMAT, got a decent ATAR, was it my interview? I had a minor existential crisis after failing to achieve something for the first time in my life. And I suppose that event sealed writing away for me for a time, because I had become more adamant than ever on becoming a Doctor.
Looking back, the next three years I spent in undergrad were some of the most forming of my life. I discovered the massive difference between studying during VCE and university, I joined all the clubs, even lead an executive for one, properly discovered love for the first time, made some hard choices. So where could I have fit writing? It was in the summer of my second year of undergrad that I found an opportunity which really appealed to me. This was all in the backdrop of me not getting into Medicine the second time and I decided to pick up that thing called ‘writing’ I’d left in a dusty glass case sitting in the attic. I discovered a social media website called DigitalFox which produced a bunch of articles relating to pop culture, superhero movies, anime, comic books, i.e. everything which was my jam. I joined up and started writing articles for them on a semi-professional basis. Soon enough I started doing paid interviews, went to pre-screenings, and writing reviews for upcoming films. It was a lot of fun. And all while I was studying to try and get into Medicine, for the third time. Something in my mind had changed during that period. I realised that while I really wanted to get into Medicine, I also really wanted to write. And that idea may or may not have been incepted by my father. My dad has a bunch of funny expressions and sayings he sprinkles into his motivational lectures. One day he told his little ‘golden rule’ something so simple that it can be applied to any situation in life, He said. “Make peace like there’s no terror and fight terror like there’s no peace.” After arguing for some hours about how stupid that was and how it didn’t relate at all to what he was telling me, the message did eventually sink in. Why couldn’t I do both? I could try to get into Medicine and write. And thankfully, after a lot of hard work and even more luck, I did get into Medicine. And luckily, after a lot of self-discipline I haven’t put writing back onto my derelict shelf, it sits with me at my table. I’m writing all the time, sometimes academic opinion pieces, some satirical pieces, I recently did an interview for the Fourth Issue of AMSA Rural Health’s Frontier! (shameless plug, please go check it out xoxo), but alas there have been no more movie reviews. I hope I can make something out of my writing one day, to take what I’m doing a step above but I suppose I’ll always find excuses to prioritise something else; like the impending approach of exams...
“...if you love something and you’re passionate about it, I’ve discovered it’s not about finding time for it. It’s about making time.” I guess the point is this; I love writing. I love expressing my thoughts eloquently, because I’m quite inept when communicating verbally. I love the ability to create a cosmos which is mine and mine alone, and be able to share that with others! And if you love something and you’re passionate about it, I’ve discovered it’s not about finding time for it. It’s about making time.
Photography credit: Julia Hembree
GORDI
// Dr Sophie Payten Dr. Sophie Payten, better known outside hospital by her artist handle Gordi is a 2018 UNSW Medicine graduate, and renowned Australian singer and songwriter. She released and toured with her debut album Reservoir in 2017 whilst studying medicine, and is recognised for her artistry as she was awarded the inaugural winner of the Australian Women in Music Award for Songwriting last year. She has also worked alongside artists such as Troye Sivan on the Australian dynamic duo track Postcard on Sivan’s album Bloom, and she has opened for artists such as Sam Smith and Bon Iver. Interview by Linna Huang
Good afternoon Sophie, thank you for speaking to us today! You are both a doctor and a musician by trade - could you tell us a little about how that looks like for you in your life at the moment? I did my undergraduate medical degree at UNSW and now I’m working at Prince of Wales Hospital, so I’m currently doing my internship year and doing my emergency term. Throughout my time at uni, I was also kind of pursuing a music career - which was started out as just me playing gigs around Sydney and then I put out a song which was added to Triple J, which made it turn into more than a hobby, so while I was at UNSW I was touring a lot. I actually took an additional year to finish the degree and the faculty at the uni was incredibly supportive and let me do my final 2 years over 3 years because I was away touring a lot of the time. I started working this year which has been a bit of a year off - at least off touring. I had my four weeks annual leave earlier in the year, and during those four weeks I recorded my next record that will come out next year, which I will be taking off medicine. Uni was a bit of a balancing act, but now with working it’s
more of a “be in the medicine world for a while and then take some time off and go back to the music world” and keep sort of going back and forth for as long as it seems feasible. Do you think these two interests will ultimately lead to a choice or more like a bit of a compromise? I think it’d be more of a compromise. Most people I speak to are sort of like “You’ll have to choose at some point” but I think it will be more about compromise. There’s been so many times where I think it’d be more of a choice but I’ve kind of made it work. I guess the compromise will be when I’m coming back into medicine after having a break to put out this next record - whether that will limit the jobs that I get. But I’ve spoken to a lot of people and I’ve actually just let my hospital know that I will be resigning at the end of the year and they were very supportive and suggested that if I were to come back and get a residency job then that could definitely be a possibility, so I think that I’m getting used to the idea where the wind blows me a little bit with regards to managing both of them. So I’ll spend one to two years in
the States pursuing music, and then once that touring and album cycle runs its course then I’ll assess my options. I think medicine is becoming a lot more flexible than it used to be - a lot of my friends who are finishing their residency years are going to take time off and do locuming, go travelling and practice overseas and doing a whole bunch of different stuff and so I think it’s becoming a lot more accepted now that junior doctors are not just getting straight on a training program but taking more time to do interesting things and the common feedback that I get is that when you go to eventually to apply for jobs it actually resonates better if you have some life experience which hopefully I will have. Being a doctor and singer-songwriter you definitely touch peoples’ lives in very different ways. What’s been your favourite part of it all? I think I’ve always thought there is this nice symmetry between music and medicine. You’re hopefully making a tangible positive difference in someone’s life; if you’re releasing a song, you might not be as aware of what you’re doing someone versus suturing up a lacerated arm of someone who’s sitting right in front of you but I think you’re trying to make a positive effect. I think medicine is such a wonderful career for that and I think as an intern you can lose sight of that a little bit because there is a little chunk of the year you feel a bit more like a glorified secretary than a doctor; but doing after hours shifts or during an ED term you really get to sink your teeth into what practicing as a medical officer is actually like. In terms of the internship this year I’ve really loved hands on practice and I feel like especially in my current term in emergency I always seem to do 20-25 things everyday that I’ve never done before which I think is pretty cool and there’s not many jobs where you could say that - where you’re having that kind of experience. Music is a totally different beast. I’ve had a lot of really wonderful opportunities. Highlights have been playing in the Opera House in Reykjavík in Iceland, the Primavera festival in Barcelona; touring with a bunch of my favourite musicians like Bon Iver, Tallest Man on Earth, Of Monsters and Men - all those touring opportunities have been really great.
I think like anything, you just have to balance - can’t try to keep all the balls in the air and ultimately do what makes you happy and what makes you feel fulfilled. What things did you learn in med school that have helped you in being an artist and vice versa? Resilience. When I was sitting my final exams at the end of 2017 and in the same four weeks I was putting my debut record out, I toured in the States, did a tour in Australia with the Gang of Youths and I had my flashcards backstage walking around trying to get it all in my brain and it was incredibly stressful. I think it has shown me that if you really want to get something done you can do it, and that leaning on the people around you is really important in whatever you’re going to do. I found that I spent a lot of time leaning on my friends through being an intern and your cohort, and finding people who are having that shared and common experience because doing that pursuit alone can be really isolating and can be really challenging. So I think finding those people who are going through the same thing as you and really leaning on them is super important. Carving out time for yourself when you can amongst studying like crazy for those final exams and allowing it all to be kept in a bit of perspective; that you know the world’s not going to end if you don’t get the mark you want, or even if you have to resit the exam. Taking a bit of pressure off yourself has been what each has taught me about the other. The thought of you doing flashcards backstage is amazing! It was pretty funny - the Gang of Youths show that they played at the Hordern Pavillion was on the Friday night, and I had my first multiple choice exam on the Monday, and I was pacing up and down in the green room, and they said “you’re going on in 5 minutes” and I was like “how many flashcards can I do before I have to go on…?” So I’m very happy that time of my life is behind me. It’s much better because even though internship brings its own challenges, not studying is just the best - like it’s the most incredible change in life.
“...I was pacing up and down in the green room, and they said “you’re going on in 5 minutes” and I was like “how many flashcards can I do before I have to go on…?” Going back a bit, how did your interest in medicine start?
Yeah, I don’t know to be honest. I definitely like generalist things - I know I don’t want to focus on one body system. Whether that’s GP or critical care, ED, or ICU - that kind of stuff. To be honest, for the next 5 to 10 years if I’m trying to balance music, the easiest way I could do that with medicine is by locuming in Emergency Departments and you can kind of do a week somewhere and you don’t have to get attached to a team like you would in any other specialty; and it’s really good medicine and you learn so much, and you really brush up your skills. So I’ll say I’ll work in critical care, and see what piques my interest later on.
Last year you were awarded the inaugural winner of Australian Women in Music Award It’s a bit of a cheesy story but it’s quite true - it for Songwriting. How important to your work is was a real moment for me. I was in year 9 and considering the impact you may be having as a sitting in a science class and they were going young influential female performer? through the physiological reason why “practice makes perfect” - that, on a very basic level, To be honest, I still feel very much at the stage messages travel across synapses and neurons of being influenced than being influencing. But I through those pathways, and the body’s able to think that those awards are such a special thing recognise those pathways a lot quicker for the to be created and you know, in both medicine ten thousanth time you hit a tennis ball compared and music there’s still such a long way to go to the first time for example, and your body’s like towards gender equality. In music, it’s really the “Ah, I know what I’m doing”. I just thought that was time for female artists at the moment, especially amazing, and I really am a huge nerd out fan of in Australia. You listen to Triple J and all the big physiology, and it just seemed crazy that I would solo artists are these strong powerful females. go through life and not understand everything But then you hear all about festivals that are I can about the human body. So that’s kind of booking a majority male lineup; there’s just a lot what sparked my interest. I always wanted to of stuff that’s incongruous and a bit troubling do something that was in a service industry, like when you feel like you’re out there doing your teaching or something where you can make a best but there’s forces at work in the world that tangible difference in someone’s life. I think it’s are limiting what you’re able to do as a young pretty cool that people come into a hospital or woman. I think that exists plenty in medicine a GP practice because they’ve realised they can too, and it’ll take a long time for those cultures no longer help themselves and you’re the person to shift and they definitely are already. A big who can give them that information. Even doing part of that is if you have any sort of platform to this internship I’ve realised a lot of the time you’re influence and cause change then you do have a not fixing people or you’re not actually solving responsibility to use it. their problem or medical condition; but you’re just giving them the knowledge you’ve acquired And your take on queer representation? over a number of years and you put them at ease. I think the learned ability to do that is a real I think queer representation in music has always privilege - that’s why I wanted to do it and why I been big. There are a lot of musicians out there want to keep doing it. who make up the queer demographic and have been big voices for the queer community; You mentioned previously that you were promoting change in everyday culture. It’s funny interested in pursuing general practice; is that I guess, growing up in a generation where I feel the case now, or do you know where you’re we’re all a lot more like “Sure!” about someone headed in that sense? being on the spectrum of sexuality or being in
the queer community. In our generation is not a big deal and not something that has to define you, just because you put yourself in one of those categories. I think it is a long, long, long conversation that’s been happening for many, many years and it is because of a whole lot of generations that have come before us that are unable to say that. It doesn’t necessarily have to define you, it can just be a part of who you are. We’re all very fortunate for those who have fought long and hard for us to feel safe and feel like we can be who we are. Of course there’s still a long way to go, it’s not that way all around the world. But music and the music community has always been a voice for people who feel like they don’t have a safe space to be themselves. I think it’s important to always advocate for vulnerable people. I’m sure medical students would love to pick at your brain for some advice. What do you think is one thing everyone should be doing in medical school? Having fun. Everyone’s always in such a rush to get through medical school, get onto a training program and all that stuff. You have your whole life - I’m saying this as a wise old 26 year old - to meet those goals, to get past those little goalposts you’re setting for yourself. All that pressure of accelerating through life, and people who do medicine are truly those kinds of people because they’re all very smart, and they’re all putting a lot of pressure on themselves to achieve great things and that’s wonderful - we need people like that in the world, but there’s such a culture of pressure and burnout. I’m even finding threequarters of my way through internship that I’m a little burnt out from it all as well, because it’s so rewarding but also so constant. It totally absorbs you and swallows you, so I think taking time, really preserving a hobby - you don’t really have to have a whole career on the go - but preserving a hobby, preserving good relationships is something that takes time and effort and work, and you can really lose the thread of that if you lose yourself in medicine which is such an all consuming career. So I think being careful in that respect, and taking time to enjoy life, and have fun, and travel, and take time off - which shouldn’t really be held against anybody because you’ll end up being a much happier and fulfilled person I think.
What would be your advice to a medical student who maybe wants to do venture and do something else but feels they are “stuck” in their career choice? I think well, you know: “who are you living your life for?”. If you want to do that, that’s what you should do. No one can really tell you otherwise people will definitely try, as people have tried to tell me on multiple occasions. But so what, if you think I’m going to take 5 more years to become a consultant than I would have otherwise or 10 years, or 15, or 20? You just have to not give a s*** about what other people think and really just run your own race and do the things that make you happy. Because then you’ll get 10 years down the track and think “Oh I should have done all those things when I was in my 20s because now I have a mortgage and a family and all these responsibilities” whereas we have the great fortune when we’re young, and this age you have a lot more freedom to go down some rabbit holes and go down different paths that might not lead to anything, but I think it’s an important part of life to explore all those possibilities.
“...we have the great fortune when we’re young, and this age you have a lot more freedom to go down some rabbit holes and go down different paths that might not lead to anything, but I think it’s an important part of life to explore all those possibilities.” Finally, could you give us a bit of an insight as to what your study playlist looked like in medical school? Yes, it was all instrumental actually, because I found that if I listened to words - I’m probably going against myself here because I don’t have any instrumental music, and therefore can’t listen to my music - I always studied better to songs that didn’t have any words. I had a playlist on Spotify called “Ambiguous Storm” because it was a lot of deep dark and emotional instrumental stuff it was an excellent study playlist. It’s actually on my Spotify artist profile if there are any struggling medical students out there.
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By Matilda Robertson (Bond University; Year III) She was your passion I could see that from the start. I tried to deny it, In order to protect my heart. But I became weighted down. My mood deflated. Slowly but surely, Love turned to hatred. Yet, you maintained I was always at fault. That my overthinking mind Had opened a non-existent vault. The thoughts of not being enough Pushed me into a deep, dark hole. And despite all your words Your actions didn’t even attempt to rescue my soul. A passion ignited in me I found something I wanted to pursue... So I found a strength I didn’t know I had And called it off between me and you. Your lack of fight-back Was telling indeed It was the proof I had needed To know I had been freed Out of a million emotions The main one was relief Though because I had internalised this all I think majority of people were in disbelief But life moves on And I’m no exception I’m just taking some me-time To learn a valuable life lesson I see you’ve pursued your passion I knew my gut was right Screw you for making me feel guilty That I thought you were thinking of her at night I should’ve called it off when I first felt you were missing Oh, the beauty of hindsight!
My Introvert Days, GIT Troubles, & The Hunger Games
By Yashaswini Makkoth Griffith University; Year I “Do you know where the lavatory is?”- this was the ending sentence to a story written by my friend in Year 7 English. I do admit that it’s not an inherently inspiring sentence, but it was the build-up to those final few words which left a lasting impression on me. The story revolved around a man chasing after another gentleman and led you to think that once this man finally caught up with the gentleman, something ominous would happen. But in fact, the man simply wanted directions to the nearest toilet! It’s this element of mystery, suspense and ingenuity that allures me to stories. However, if I’m being honest, my love affair with stories began long before that fateful afternoon in primary school. In fact, over the 12 years leading up to that afternoon, I had moved to six different schools because of my father’s job. While it meant that I never really stayed long enough anywhere to develop deep roots, I still managed to enjoy the constant change in scenery. I got to see the rich culture of Papua New Guinea (PNG), the busy life in the city as well as the more laid-back lifestyle of Hervey Bay. During this period, I met many wonderful people, from all walks of life. I adapted to change at an early age. But more importantly, I began to uncover my love for stories- not the ones written in books, but those of people, built upon the connections you make with them. I was quite a shy girl back then, not that I’m very extroverted now, but I’d like to call myself situationally extroverted nowadays. Nonetheless, my life as an introvert allowed me to take time to listen and to observe the stories of those around me. But it was my first move from PNG to Australia that inspired me to become a doctor. I had a stomach-ache that couldn’t quite be resolved despite visits to numerous medical professionals. On the good word of a family friend, my parents took me to see one particular doctor. This doctor talked to me as a kid rather than a patient. He made me laugh and gathered my history with a subtlety that reflected years of experience and his passion for the job. I was only six at the time, but I still remember how in awe I was of him. I knew then that I wanted others to feel the same way. I wanted others to feel heard in a medical consult and so, with the blind faith that only a six-year-old possesses, I declared to my parents that I too would become a doctor one day. So how does The Hunger Games fit into all of this? It all started in Year 9 English, when I received my first C+, which for a type A personality, was as devastating as it gets. My teacher told me that my assignment lacked the sophistication that comes from reading extensively. After a few tears and a copious amount of self-pity, I decided to take her advice and borrowed The Hunger Games from the school library. For the first time in my life, I fell in love. Reading was like watching a movie in my head, but so much better because I could imagine the characters and the world as I pleased. And that my friends is how I found my passion for stories. The thing about stories is that they are everywhere- in the books we read and, in the connections we make with those around us. I find myself in awe some days- who would’ve thought that a chance encounter with a doctor 15 years ago would lead me to where I am today? While life is busy, I find a plethora of opportunities to pursue my passion for stories- from indulging in the juicy drama of trashy reality TV, to the profoundly moving stories of patients. I sit here writing this piece as the credits for The Hunger Games roll on TV- coincidence? I think not. I’ve actually never believed in coincidences, but that’s a story for another day.
I am
by Yangzirui Fu Australian National University; Year 1
“Congratulations! You are having a.... boy! No, wait, girl! Hmm, wait. What is it?” To my parents’ surprise, I was born. I am one minute old when they determined that my genitals are different. To use their language I am to be “corrected” as if I am wrong. I am one day old when they told my parents that this “correction” needs to be done, sooner than later for my benefit as if I will be benefited. I am one year old when they said to me that I am a girl, but needed something extra to keep me “a girl”. They called it the solution, as if it wasn’t a manipulation.
I am five years old when they confused me called me name that wasn’t “she” because I needed the “extra” to keep me a “she”. I thought they were my friends, as if they can understand. I am fifteen years old when he asked me why my private parts looked weird. I was so ashamed and embarrassed. I thought I was the one to be condemned, as if he wasn’t the perpetrator. I am twenty years old when I found them the same as I, as lost as I, as glad as I, as singular as “I”. I am twenty-five years old when she embraced me into her arms. You can be whoever you are, woman or not, different or not. I am this, that, them; prudent, valiant, strident, existence.
Professor Deborah Bateson
Reproductive Rights: An Australian Perspective An interview with Professor Deborah Bateson by AMSA Sexual and Reproductive Health This year, AMSA SRH were lucky enough to meet with Professor Deborah Bateson and talk all things sexual and reproductive health. Professor Bateson is the Medical Director of Family Planning NSW and a former Global Director for Marie Stopes International. She has worked in the area of reproductive and sexual health, both nationally and globally, for 20 years as a gynaecologist, educator and researcher. This interview was conducted prior to the NSW abortion law reform which was passed on the 26th of September of this year. Professor Bateson was a leader for the successful campaign, and her tireless advocacy in this area has been invaluable for reproductive healthcare both in Australia and across the globe.
Thank you so much Professor Bateson for meeting with me. I was wondering if you could start by telling me a little bit about your career and how your passion for reproductive rights has influenced you throughout? I’ve had a very, very interesting career. I started off doing biochemistry and then tropical nutrition at London’s School of Hygiene and Tropical Medicine. Then I actually worked in Africa for a few years and decided that I really wanted to study medicine. So I ended up studying medicine in Hong Kong and then came to Australia. It was a really interesting time because when I was working in Tanzania, people were coming to our hospital with what was known as slim disease, so really I was seeing some of the first cases of HIV. When I came and worked in Australia, I was at St Vincent’s Hospital in the 90s at the height of the HIV epidemic. It was a very sad time with a lot of young men dying on the wards. I then ended up doing the family planning course with Dr Edith Weisberg, a pioneer of women’s health. I just loved it. I realised that this was the place where my passion was, that I could really make a difference, I loved that privilege of hearing about people’s intimate lives and playing a role in supporting the decisions they were making.
I was very lucky. To start with I spent some time in Ghana and in Kenya with Marie Stopes International, and went on the road where they do amazing things like vasectomies and tubal ligations and IUDs and implants, which gave people choices around contraception. It really just is about ensuring that women and their partners have access to these services and that reproductive rights is not just about access to services alone, but also access to information. My next question was how have reproductive rights changed in Australia across your career? Has there been progression in this area?
I think that there’s a very varied picture. I think first of all, the term reproductive rights, particularly in Australia, perhaps wasn’t used so much in the past. Now it’s very apparent that a lot of the reproductive injustices have occurred and now we’re much more cognisant of this terminology. There was an investigation relatively recently around the misuse of Depo Provera injections. Certainly around the world, many Indigenous communities were coerced into using Depo injections, as well as young women in institutions including those with intellectual disabilities. It’s recently come to light that some institutionalised young women were I’ve had a varied career here as Medical Director. given Depo injections before it was even licensed I still do clinical work in Fairfield in our clinic, a for use. very multi-cultural clinic, research which has been excellent, and a lot of training of GPs, medical The concept of reproductive coercion is students, and advocacy. So it’s just been a really increasingly recognised, whereby people are fantastic career, I have to say. forced, against their will, to use contraception, or to not use contraception, to continue a pregnancy, And I know that you’ve also done some work with or to not continue a pregnancy. That can happen Marie Stopes International, could you please tell sometimes at a whole of country policy level, me about that experience? if we think about the one child policy in China for instance, but sometimes at a healthcare I was the Global Director of Marie Stopes provider level and also at an intimate partner International in 2013 and it was just an extraordinary level. There is increasing awareness of equity of opportunity. The organisation delivers, I think at access to contraception and abortion services last count it was across 32 countries around the and information that is free of coercion. But while globe, a whole range of reproductive health and improvements have been made in some areas family planning services, including safe abortion there are also backwards steps in others and we where permissible by law. We know that the laws can never take anything for granted. around abortion are very varied around the world, and obviously we can’t take those for granted. There are some challenges at the moment, but Marie Stopes just delivers amazing services, including safe abortion but also including a range of contraceptive services.
Absolutely, and I was actually going to ask you a question about reproductive coercion. I think some people may not be familiar with the severity of barriers to access, and that domestic violence and intimate partner violence can accompany poor access. I was wondering if you could comment on how reproductive rights intersect with domestic violence? At Family Planning, we’ve been screening for domestic violence for many years now. But importantly, we’ve just recently added some questions surrounding reproductive coercion at an intimate partner level - we know that it’s part of that spectrum of intimate partner violence. I’ve certainly heard from women who have had their contraceptive pills hidden, or flushed down the toilet for instance. Depo Provera can be a useful form of contraception in these situations because it’s hidden and can’t be detected, although some women can still find it difficult to visit a clinic for repeat injections without their movements being tracked. As I mentioned before, when we talk about reproductive coercion, it’s not just at a partner level, it can be at policy levels and country-based levels. We work very closely with our social worker team at Family Planning and they play an incredibly important role in relation to reproductive coercion which relates to disempowerment and power imbalances. Reproductive coercion can take many forms including coercion around using contraception or not, having an abortion or not having an abortion and I have also encountered coercion around using assisted reproductive technologies. From your experience, what are the greatest barriers for general practitioners to provide medical abortion? That’s a very good question. We did some very interesting qualitative research with GPs in NSW, and we know that very, very small numbers of GPs are providing medical abortions. Through our research, we found that there were several reasons for this. Certainly, some GPs don’t feel as though it’s within their scope of practice, and they’d rather refer patients to a specialised clinic. But we did also find that for practitioners who really wanted to provide medical abortion, there were just so many structural barriers put in place to prevent this happening. Some barriers related
to feeling stigmatised, and that they’d become known as ‘the abortion doctor’, but they also felt very professionally isolated. We are now in the process of developing communities of practice to support GPs who are providing medical abortion in their practices so they can share their experiences and feel supported.
“...for practitioners who really wanted to provide medical abortion, there were just so many structural barriers put in place to prevent this happening. Some barriers related to feeling stigmatised, and that they’d become known as ‘the abortion doctor’, but they also felt very professionally isolated.” We also found some other challenges, including local pharmacists not providing the medications – sometimes because they were conscientious objectors but also because it was out of their comfort zone. Clear pathways are needed to support GPs in providing holistic reproductive healthcare. A key finding that came out of this research was that sometimes there were real difficulties in referral pathways to local hospitals, or gynaecology services, in rare cases of complications. This also made it very difficult, particularly in rural areas, even for very determined GPs who wanted to provide this holistic service for their patients and - in some cases, it was just too hard. We’re in the process of decriminalising abortion across Australia, and we’re part of a campaign now to decriminalise here [in NSW] and to remove that stigma not just with doctors but at a community level as well. This is an important step in supporting doctors. I guess it’s important to ensure that GPs don’t have any reservations. There’s a degree of training to provide medical abortion as well, isn’t there? Well it’s perfect to talk to you about this because we want to make sure that we actually embed training around abortion care to medical students, and that there’s exposure to abortion care for gynaecologists and GP registrars training. At the moment, yes, there is compulsory GP training in the form of an online module for any doctor who
wants to provide medical abortion. It’s around 4 hours of time, and it’s essential to do that training of course, in order to feel confident. Again, destigmatising abortion care through exposure is an important way forward. We know that in many countries now - in the UK, in Scotland, in Sweden - really the proportion of medical to surgical abortions is really tipping very much in favour of medical abortion rather than surgical abortion. We want women to have choice of course, and for abortion care to be close to where women live so they have autonomy and can make informed decisions - medical abortion is a great service for a GP to be able to provide. So now some questions about patients - in your experience, what are the most frequent barriers for patients to access abortion? If we’re talking NSW, the overwhelming majority of abortions are provided in private clinics, with an upfront cost. These services have to charge these costs as there aren’t any alternatives, with very few publicly funded services. There’s no pathway into public hospitals for abortions except in very rare and complex cases including for foetal abnormalities. That’s not to say that they don’t occur, but it can be very challenging and requires a lot of advocacy. So I think costs can be quite a barrier, particularly for women living in rural areas, because there’s very few rural private services – the clinics are mostly along the Eastern seaboard. Women have to travel and pay for accommodation costs, and they might need to have their children looked after at home. These costs due to a lack of local access are real barriers for people. We know that most abortions do occur early, the vast majority before 14 weeks, and as time ticks on the costs increase quite significantly. The later gestation abortions are
“I think costs can be quite a barrier, particularly for women living in rural areas, because there’s very few rural private services – the clinics are mostly along the Eastern seaboard.”
always due to very complex medical problems and foetal abnormalities or highly complex psychosocial circumstances and women who are very disadvantaged can face overwhelming barriers. We spend a lot of time helping women navigate whether they can get loans, so these are very big challenges. There are some other challenges which haven’t been addressed in NSW just yet, but Victoria has a government funded website which shows women where to go for abortions, and there’s another great Queensland website called Children by Choice - women can sometimes just simply find it difficult to know where to go. There have been some studies conducted in Victoria where they looked at delays from conscientious objection to abortion, and we now want to ensure that it’s embedded in NSW laws that people have to refer on and provide that transfer of care in a timely manner. I think it’s very important that doctors are able to hold conscientious objection but I just think it’s essential that that’s transparent and that there’s appropriate referral in a timely manner. With respect to educational barriers, because you did speak about that earlier, are there particular groups where you think education might need to be more nuanced, for example people with intellectual disabilities or people from linguistically diverse backgrounds? Oh I think that’s absolutely right. I think that lack of information, particularly in languages other than English, presents significant difficulties for people from culturally and linguistically diverse backgrounds. There may be some cultural challenges which also make it difficult for people to seek information due to stigma and shame. And when we consider people with intellectual disability we need to consider a person’s capacity to consent to the procedure. Disability can range from mild to severe and there are lots of supports in place to make sure that people who need an abortion and are able to make a decision themselves can access services. For people who are unable to consent there are clear laws in place to safeguard people’s rights. It’s important that we do have that accessible evidence-based information available to people, and for young women as well. Across the ages, across the socioeconomic backgrounds - we
know that women who have abortions come from diverse backgrounds. Sometimes we can make assumptions about who’s having abortions but we know that people of all backgrounds will have an abortion including women with children, married women and older women.
hidden. There’s a whole lot of factors, and I think it’s just for us to understand that contraception is not just the pill, and while some people may choose the pill, there are many other options.
And through that research did you find that the way that doctors engaged with their patients And I think the same thing goes for contraception influenced their choices as well? - as in the groups of women we assume use contraception. Do you think there’s anything about Communication is absolutely key and I know the way we use and administer contraception through medical schools now that communication currently in a healthcare context that needs training is improving all the time and is very different to how it used to be. Communication and improving in Australia? listening is so important, particularly for young I think so, I think there’s always room for people seeking medical care and advice. There improvement. I take my hat off to GPs because was an interesting study done at Family Planning they have an incredibly busy time - managing NSW with young culturally and linguistically diabetes one minute and contraception the next diverse people seeking reproductive and sexual - and I think it is very challenging in such a short health services. The results were quite interesting because we found that, rather than wanting to have time frame to provide holistic information. a doctor from a similar cultural background, they I think we need to ensure that people have the really wanted to interact with someone who was information they need to make those choices, rather young. Again, it just reflects the desire of those than just having a routine pill script each time they young people to be able to engage in a meaningful go to the doctor. There’s a lot of misinformation way with their healthcare provider. and mythology about contraception. I mentioned LARC before - we know that they’re highly effective This next question is more about sexual education. but not everyone wants a long acting method, they Do you think that sexual health education in may not want something in the uterus or the arm schools could be improved in any way? or conversely they may be very happy with this idea - it’s all about personal choice. It’s just about I think we’ve made some positive steps in the past few years but there is still much room for raising that awareness. improvement. There is growing recognition of the concept of ‘comprehensive sex education’ which “...we need to ensure that people have adopts a human rights approach and encourages the information they need to make those all young people to develop the knowledge, skills, choices, rather than just having a routine attitudes and values necessary to make considered pill script each time...” decisions relating to their sexual, reproductive and interpersonal life. It is essential that sexuality We did some interesting qualitative research with education is delivered by appropriately trained, young women. We published a paper on young skilled and confident people in order to meet the women’s interactions with doctors and found a diverse needs of young people. Unfortunately wide range of results. We know that people don’t we know that the delivery of sexuality education always feel as satisfied with their interactions varies hugely across schools and it may often fall around contraception as they could do. I think on teachers who feel ill equipped, don’t feel up to we have to understand that contraceptive choice date with the latest information and simply feel relates to a whole range of factors - effectiveness out of their comfort zone themselves. I think it is is just one of the factors. It may be the effect on imperative that age appropriate sexuality education their sexuality for instance, it may be side effects, is delivered consistently across schools by trained it may be that they want other benefits with their people who have got the skills, confidence and contraception for acne or heavy periods, it may knowledge to communicate effectively to young be that they’re experiencing reproductive coercion people. Part of this education needs include the and they need a method that is discreet and can be development of health literacy – where to go for
credible information, understanding what’s normal and what’s not when it comes to bodies and knowing when to seek medical advice and from where.
This is my final question for you. In your experience, what are the barriers for the LGBTQI+ community when it comes to accessing abortion and contraceptive services? Do you think that there are additional barriers for people in this Do you think sexual health education in medical community? schools could be improved and how? I think there are additional barriers for LGBTQI+ Again, I’ll say there’s always room for improvement. people in relation to accessing abortion and I’ve been involved in teaching ‘Sex, Ethics and contraceptive services which are already the Adolescent Patient’ at Sydney Uni for some challenging to access for many people, including years now. I’ve got many colleagues who do young people, those in rural and remote areas, similar things around the country. It’s always very people living with disabilities and people from well attended with lots of interesting discussion culturally and linguistically diverse backgrounds. which is great but this does suggest there could LGBTIQ+ community members frequently report be scope for greater engagement, particularly in negative healthcare service related experiences relation to communicating with patients about sex with concerns around judgements, confidentiality and sexuality. We’ve conducted some research and assumptions of heterosexuality and with young people in the community about their perceived discomfort on the part of health care interactions with doctors around sexual health. providers. Providers may also lack knowledge and Doctors themselves can feel under confident, communication skills, have a lack of resources and feel that they don’t have the correct language referral networks - while services are encouraged to use during sexual health consultations and to become inclusive of sexual and gender diversity feel nervous about making mistakes or nervous (e.g. through the Rainbow Tick accreditation about simply talking, about sex and sexuality with program), there would only be a minority of patients. We also know that we can sometimes providers who would identify as being ‘LGBTIQ+ make assumptions about people in relation to welcoming’, although hopefully this will change their sexual health including assumptions around through inclusion in medical school curricula. gender and sexuality so I think there’s a lot of scope Provision of inclusive, respectful, non-judgemental to ensure that we are offering the best possible care should be the aim of all of us as doctors. practice-based training. Clinical A/Prof Deborah Bateson Deborah is Medical Director of Family Planning NSW and holds honorary positions as Clinical Associate Professor in the Discipline of Obstetrics, Gynaecology and Neonatology at the University of Sydney and AdjunctProfessor at the Centre for Social Research in Health, UNSW, Sydney. She has worked in the area of reproductive and sexual health for 20 years as a clinician, educator and researcher and her current work focusses on enhancing equitable access to contraception, abortion care and cervical screening. In 2013 Deborah was the Global Medical Director for Marie Stopes International and she is the past Chair of the Australasian Sexual Health Alliance and is a member of the RANZCOG and RACGP Sexual Health Special Interest Groups. Deborah provides frequent commentary to the media on a range of reproductive and sexual health issues including abortion law reform in NSW. AMSA Sexual and Reproductive Health AMSA Sexual and Reproductive Health (SRH) is an Australian Medical Students’ Association (AMSA) Global Health (GH) initiative providing a platform for medical students to educate, engage and advocate for sexual and reproductive health issues locally and globally. Our scope encompasses the wide range of sexual and reproductive health issues including but not limited to menstrual health, comprehensive sexuality education, sexual health, contraception, STIs and HIV and AIDS, safe abortion care, maternal and child health, queer and gender diverse (LGBTIQ+) health, female genital mutilation (FGM) and obstetric fistula.
From the President Dear AMSA family, Whether you have just wrapped up your first year of medicine or are stepping into your internship, 2019 has been a year that has given us surprises and challenges in troves. I sincerely hope that you have been able to find something in AMSA this year, whether you attended an event, participated in Vampire Cup, read the Internship Guide, or made your voice heard to your AMSA Representative. It is difficult to boil down so many student-led initiatives into a few dotpoints, however I hope the graphic featured in this newsletter gives some insight into what AMSA has achieved this year. I am constantly in awe of how medical students are able to come together to take care of each other and pave the way for progress. We have led the charge on advocacy for climate change and health, harm minimisation, rural workforce and the mental health of our peers. We have also felt some great disappointments this year, especially the mistreatment of medical students and junior doctors, mandatory reporting reform and the repeal of the Medevac bill. If you feel passionately about issues that face medical students today, or issues that affect healthcare as a whole, there is a place in AMSA for you. It has been an absolute privilege to be your AMSA President this year and I am so grateful for everyone I have worked with this year. I am very lucky to be surrounded by people who are in it for the right reasons - to make the medical school experience the best it can be for themselves and their peers. I would like to sincerely thank my National Executive for all the hard work they have done in keeping AMSA up and running and all 22 MedSocs for all their collaborative efforts in ensuring AMSA does its best for the students they represent. 2019 will be my fifth year being involved in AMSA and my, what an incredible five years it’s been. Thank you to everyone who has supported me this year. It has been an honour representing you all. Jess.