Panacea Volume 52 Issue1 by The Australian Medical Students' Association

Panacea VOLUME 52 ISSUE 1 JUNE 2018

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Editor’s foreword

Contents

Help Us and We’ll Do You Proud

What We Expect From Ourselves

Untitled, Unmastered

Alex Farrell

Jumaana Abdu

Jasmine Ark

I am fearful

Mental health and medical students: It’s not me, it’s you

Interview with Dr Vijay Roach

Kalgoorlie Super Pit

Wounded Healers

To All the Colour In My Life

Perspective: How we see something becomes our truth

Dear Past Self

Zahraa Ahadzada

Imogen Janus

Victoria Cook

Sylvia Rienks

Charlotte Krones

Jessica Yang

Thaddeus McFarlane

Yun Megan Foo

Medical Students Are Sick of the Government Harming Refugees in Detention 21 Carrie Lee

Vampire Cup Olivia Ferry

NLDS 26 Phoebe Macintosh-Evans, Yun Megan Foo

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Editor’s foreword Are you comfortable talking about your mistakes? Making mistakes is an inevitable part of life, but for us as future medical professionals, the stakes can be so much higher. The recent manslaughter conviction against British paediatrician Dr Hadiza Bawa-Garba has shaken medical professionals around the globe, including here in Australia. It led to a discussion on the gaps in the medical system and need to provide doctors with a safe environment to be honest and transparent in their reflections and self-appraisals. Alex’s President Address at the 2018 AMA National Conference discusses the gaps in the system and what doctors can do to make a change. The pressure of avoiding mistakes could take its toll on the mental health of doctors and medical students alike. Issues on mental health have been explored in the opinion piece Mental Health and Medical Students: It’s not me, it’s you. and the reflection Wounded Healers. Self reflection on past experiences is a vital element of personal growth, and Dear Past Self is a student volunteer’s personal reflection on the mistakes and lessons learnt along the way. The article Perspective: How we see something becomes our truth reflects on how a shift in perspective can change the way we think. Beyond the theme of making mistakes, this issue of Panacea also exhibits creative pieces. The creative writing piece What We Expect From Ourselves is a short story that captures a moment in time, while the poem I Am Fearful speaks for all

of us when it voices the fears of medical students on our journey to become competent and caring clinicians. It also includes an interview with a doctor on career choices, burnout, and dealing with failure. As well as an opinion article on the appaling conditions that our government subjects refugees in detention to. You can also read the recap of the amazing work that our AMSA Project Vampire Cup has achieved this year, and an account of the annual NLDS event held in Canberra. Aside for the articles, this issue of Panacea also includes amazing artwork Untitled, Unmastered, and Kargoorlie Super Pit, as well as photography To All the Colour in My Life- where the artists also reflect on how creating art is a process of making mistakes and taking things one step at a time. Thank you to all the authors who have contributed, and to Jessica Redmond, Cathryn Youings and Alex Farrell for the support in compiling this issue of the Panacea. Warmest regards, Lucy Yang AMSA Publications and Design Officer UNSW V

Help Us and We’ll Do You Proud AMSA President Address at the 2018 AMA National Conference Alex Farrell UNSW V

This is the full text of a speech given to the Australian Medical Association’s National Conference by Alex Farrell, president of the Australian Medical Students’ Association, in Canberra on Sunday, 27 May 2018. Reprinted with permission.

ON my first day of medical school, we were asked to look on either side of us. It was a fun guessing game – which of us three would develop mental illnesses as part of our course. A few months later, I first became involved in AMSA [Australian Medical Students’ Association] because, as a student starting to see the broken parts of our system, it seemed to be where stuff got done. Doctors, and by extension medical students, hold a trusted place in society, and I saw AMSA bringing us together so we could use our collective political capital for actual outcomes. Realising that students’ voices mattered in the conversation, and that, through groups such as AMSA and the AMA [Australian Medical Association], I could contribute to real change, was incredibly empowering. It was also daunting, because we still have a lot to work on. When our organisations speak out, people listen. Students will remember the AMA joining us in the fight for marriage equality for a long time to come. It was a powerful signal to the Australian community that doctors support our queer patients and peers, at a time when many were hurting. It mattered. The AMA speaking out on the health of refugees on Manus and Nauru mattered. That is quite the responsibility. Here in this room, you are the people who will continue to set the AMA’s vision and messages going forward. Often, that will be on issues affecting the health of all Australians. For today, I want to look a little closer to home, at medical culture.

Photo credit: AMA Media

I am often told that when it comes to changing culture, students are the way forward. This year, I’ve sat in countless meetings where reassurances have been given that our problems will be solved, because the younger generation will eventually reach the top, and we have the mindset to create “the change”.

The medical students of Australia are extraordinary. But that is a huge burden to place on our shoulders alone, without the structures to support us. We have the least power, and often the most to lose. “Generational change” is a myth when the problems lie in a system to which the upcoming generations are still trained to conform. They will continue to perpetuate that culture, unless it is actively disrupted. We need support from you, doctors who have power in the system to help us change it. I’ve been lucky enough to spend this year listening to students and hearing their stories. I’m here representing an exceptional group with diverse backgrounds and experiences. Medical school has never been without its difficulties. While some things may have shifted for the better since your training years, in other ways we face new challenges, and old challenges we hoped would have disappeared – challenges in gender equity and diversity in leadership, in mental health and mistreatment in medical education, and in the growing training pressures that we’ll face on graduation. Gender inequity is alive and well in medicine today. It covers a spectrum of sexist behaviour, from well meaning but gendered comments, to clearly abhorrent harassment and assault. You heard yesterday about the very real barriers women in medicine face on a daily basis – the invasive interview questions, the pregnancy discrimination, the pay gap. This starts in medical school. Every female student will recall a time they were told to avoid specialties that aren’t “family friendly”. I’ve spoken to students who have been told that “there’s no point teaching them how to suture, because they are just going to become a GP anyway”. To a student whose supervisor was well known to either bully or flirt with their female students, and told she was lucky to be picked for the latter. It’s what we call unconscious bias. Women and men alike, not meaning to, doubt women’s abilities just that much more. Women need to work harder to prove themselves, because they don’t fit the leadership image we all expect to see, whether that’s in an operating theatre or hospital boardroom. It’s not really about gender or sex, it is about power and authority, and who we see holding it.

Women are under-represented in nearly every position of medical leadership. They are far less likely to be medical school deans, chief executives of hospitals, receive research grants, or be AMA presidents. They are less quickly promoted, and less well paid. The truth is, most doctors involved in the lower levels of sexism and harassment aren’t malicious. They may think they are being helpful, or flattering, or telling a harmless joke. Many never actually receive feedback that they are being inappropriate. And so, the behaviour builds, and the lack of accountability builds, and for the few with bad intentions, the opportunities to abuse power also build up. When we tolerate less confronting comments, we pave the way for them to escalate unchecked. Everyday sexism looks benign, but it has shaped what medicine looks like, from our first year university students all the way up to the people here today. In the past couple of years, medicine in Australia has been rocked by the revelation of endemic harassment. I don’t think anyone will be truly surprised when the next horrible event breaks. We haven’t changed enough to expect them to stop. But it’s not enough to wait till then to be shocked back into action. There’s no more room for apathy in this space. The same goes for all vulnerable population groups. There are exceptional Aboriginal and Torres Strait Islander medical students, but compared with other students, the barriers to graduating can pile up. Earlier this year, I was able to speak to the student representatives of the Australian Indigenous Doctors’ Association (AIDA) and hear their stories of daily stereotyping and racist comments, of being regularly told they had taken the place of someone who actually deserved to be in medicine. A survey by AIDA has found that nearly 50% of our Aboriginal and Torres Strait Islander doctors face bullying, racism or violence a few times a month, or even daily. While more and more, the make-up of medical students reflects our population, this isn’t reaching the tiers of leadership where the ability to really create change lies.

The hurdles to being leaders and advocates are only made higher when certain groups are less valued and protected in the medical sphere. For students and doctors in training, the health industry is hierarchical and rigid. Challenging norms simply isn’t safe territory. We know that most students who are mistreated during their medical training don’t report it, for two key reasons: they don’t know how, and they’re afraid of what might happen if they do speak up. When asked to elaborate, these are their responses: “We are taught from our first year that whistleblowing in medicine is career suicide”; “My supervisor could be my examiner”; “I tried — the university told me it was the hospital’s responsibility, the hospital directed me back to the university”; “It doesn’t look good for getting into a specialty program.” Even as someone who has spent this year speaking out on this issue, when I go back into clinical rotations next year, I can’t say with confidence that I’ll report bullying or harassment if it happens to me. I am worried, as so many students are, about what might happen on the wards, but I’m even more worried about what might happen with a report. Which means that responsibility to speak up lies with you. To take colleagues aside if they might be crossing lines. To create systems in hospitals where reporting doesn’t put students and staff at risk. To demand tangible consequences. We can change the structure that drives medical culture. We need only look at the issue of mental health, to see this community rally, and say “enough is enough”. The promises from COAG [Council of Australian Governments] to change mandatory reporting laws to remove barriers for health professionals to seek appropriate treatment for mental health are proof of that. That came from sustained and powerful advocacy, from students and the AMA. The work is far from done, but as a start, I’m hoping I can look forward to not hearing any more stories of students being told that seeing a GP will end their career. It won’t solve all the reasons behind poor student

mental health. As students, we are staring down the barrel of the building pressure of vocational training – there are far more of us graduating than there are specialty training places, and by the time it is our turn to apply, it will be reaching crisis point. Knowing that is the future for us, it should come as no surprise that students are doing anything we can to get ahead. Research projects in the holidays, master’s degrees in parallel with full-time medicine and part-time jobs. We can talk about work–life balance as much as we like, but while this is the status quo, mental health will suffer. Once out in the workforce, many of us will take years off from clinical practice for PhDs or other pieces of paper to make us better candidates, but not necessarily better doctors. We will follow the signals that colleges and the profession send us – for a focus on clinical education and service, like so many of you yesterday placed as a priority, they need to be recognised accordingly. When it comes to mental health, there is one area where students and senior doctors still seem too often not see eye-to-eye – resilience. For us, resilience has become a dirty word. That’s not because we don’t believe in prioritising mental wellness. It’s a word that has been overused, at the worst times. Resilience is a suicidal friend pointed towards mindfulness courses. It takes students at the darkest point, and tells them that they just should have been stronger. It acknowledges that the medical training environment is flawed, but at the same time says that the answer is fixing students, rather than seeking larger change. That is what students hear. So, instead, let’s talk about what they are being resilient against. Sixty percent of medical students have witnessed mistreatment in medical education. That’s Three in every five. Most of the time, this comes as belittlement, condescension or humiliation. Women are more likely to be mistreated in medical education than men, queer students more than heterosexual, clinical students more than preclinical. Consultants are the main offenders in half of the cases. In the medical world, we are expected to teach and lead as a core part of our work. Doctors

spend years learning to practise medicine, but are expected to teach with no training at all. Your actions matter to the students in front of you in that moment, but also for what they model going forward. We replicate the examples that were shown to us in our training – so the way you teach now will shape what the medical profession will look like in 20 years. If you want to see things change, that is the first place to start. As a teacher, model safe practice, good communication, work–life balance. A positive culture is a safe culture. I know it is not always easy. As students, we take time away from your busy days. Sometimes we don’t know how to help, and we know that our gaps in knowledge fall short of your expectations. All students know the feeling of being a burden on their team. But to learn, we need to be in the room, and we need to be able to ask those questions. Medical students want to work hard, and to be good, safe doctors. You hold the power to [have an] impact [on] the lives of your students each and every day. That’s not to say they need to be your first priority. Your patients always come first. But it doesn’t have to be one or the other. It only takes a moment to say good job, or to answer a question, or explain how to improve next time. That moment can make your student’s day. It can keep their love for medicine going through all the other parts of this profession that may otherwise leave us disillusioned far too soon. Thank you to all of you who make that effort to be positive mentors and teachers. You are appreciated. I believe that we can build a medical culture that is safe and nurturing. But it can’t wait 20 more years, when my peers are filling your seats. It has to start now, and it has to come from the top – in the way that you teach, in the way that you lead, and in the systems that you influence, be part of that change, and I promise, we will do you proud.

What We Expect From Ourselves Short Story Jumaana Abdu UNSW II She is what they call a Good Woman. The kind that often dies in stories, usually bedridden, feverish but not delirious, patient – always patient. She dies quietly and that’s how we know she is Good. It’s how she teaches other women to be Good. What else about her? Well, this night the woman is waiting for someone at a restaurant, the kind illuminated by candles and a rounded muffled ocean of voices. The leaves patterned on the dimly lit wallpaper are a slightly paler green than her dress and somewhere a fireplace or candelabra or something of the sort – it flickers across her features, alternately highlighting her goodness and… another thing, but mainly her goodness. She is also good looking in a way, but not pretty or beautiful. And her hands are not pretty. Her hands are those of a woman who has held on to too much; not in desperation but in determination, in unreciprocated strength and devotion. Good Women are often treated this way; as a guarantee. The light – ah, it is from a fireplace after all, I can see that now that the waiter has moved away – the light, it flickers once more. See again the shadowy interlude on her features, the glimpse of something else between the gentle amber illumination of a well-kept flame. Between the glow of goodness, what is there? She is examining her hands in the low light of the restaurant – they are too veiny, too solid – as she waits. Good Women wait well; it is their speciality. A man walks through the entrance. His arrival sends our good woman’s eyes up in an unexpected flash of urgency. Is this what we glimpsed betrayed on her shadowed features? Two pairs of eyes meet. See the clench of her jaw

– excitement? The imperceptible resetting of her shoulders, lower. The hint of a smile, a weighty breath. The man is suddenly seated opposite her. He moved unnoticed through the crowded room, like the unnamed shadow on our Good Woman’s face. He too has a shadow. It is in the inviting glimmer of his eyes, a shadow of indifference cast by his future self. He seems the type of man to tire of a Good Woman when she has been good to him too long. It comes to my attention that the man is accompanied by another woman. It seems she goes as unnoticed by us as she does by our two central characters. She sees them looking at each other. A smile of greeting exchanged between ageold friends, an inside joke. It’s embarrassing, really. What does our Good Woman know that she does not? She knows him, that’s what she knows. She knows the danger of twinkling, daring eyes and a man who moves like a shadow. You can see it in the caution of her gaze, the deliberateness of her breathing. She is appraising him for the millionth time, laughing at him and with him in a familiar, somehow tragic way. So that is it then. Her hands are not strong from holding on, but holding back. Now, I see. The intermittent shadow on her face is but a crack in the dam. It is in the man’s expression too. He is clearly less aware of it, but it is there; a temptation to abandon all other temptation. A longing to stop resisting, to fall back on the guarantee of an endless abyss of goodness – a guarantee that one can fall and fall and fall forever, never to be assaulted by the abrupt ending of the crevice, by the jagged base of the pit. No, falling in goodness means falling forever.

“What is vertigo? Fear of falling? No, Vertigo is something other than fear of falling. It is the voice of the emptiness below us which tempts and lures us, it is the desire to fall, against which, terrified, we defend ourselves.” ― Milan Kundera You can see him blink away this unwanted thought of vertigo, flashing a smile as he removes his gaze from our Good Woman – his good friend – laying his hand purposefully on that of his unfamiliar companion. A reminder. An affirmation of character. Our Good Woman lowers her eyes. Her expression becomes thinly polite – on her, politeness seems genuine, thin or otherwise.

of restraint appears to have exhausted her. And the glances she steals at him – the private concessions, a small, contained surrender to the heart’s desire – they carry enough weight to sink the Titanic. Even there, at the bottom of the ocean, where there can be no light and so no shadow, she would be good. She would be patient. She would not cry or struggle for breath. Good Women die quietly. That’s what they say. It’s what they will say about her. It’s what she says to herself.

A moment passes before the evening proceeds. How many of these moments have passed between them? The man hardly seems to notice it, but it causes a sort of heaviness to settle over our Good Woman. She sees he will make her miserable. Probably. Maybe eventually. Perhaps the dam walls, the restraint on her now wellcurated expression, maybe that is goodness; the denial of the wrong kind of happiness. The kind of happiness that would be a mistake. What makes happiness wrong? Wanting it too much? Wanting it so much that it takes on a physical form, a sort of heavy, sighing Want? Throughout the night, the fireplace still flickers, it dims, and try as she might to banish him from her expression, something of him stains her. He is the shadow on her face between the pulsing glow of the fireplace, that’s where she keeps him. It seems goodness is a cousin to heaviness then, to heavy secrets. By the night’s end, the strength

Untitled, Unmastered Art Jasmine Ark University of Tasmania V

Making mistakes when painting can be disheartening, especially when you put hours into your work - this is comparable to other aspects of life when you had the best intentions but still managed to mess things up. Itâ&#x20AC;&#x2122;s something you can ultimately learn from even if it doesnâ&#x20AC;&#x2122;t seem like it at the time.

I am fearful Poem Zahraa Ahadzada Western Sydney University IV

I am fearful. I am fearful that one day I will forget what it is to feel for a patient. That I will forget what it is to cry with a patient. I am fearful that one day a patient will speak to me and I won’t hear them. That one day the system will jade me and leave me distant. I am fearful that I will fall prey to compassion fatigue. That I won’t see my patients as human beings but only see them as a list of medical action items. I am fearful. I am fearful that death will mean so little to me that the deaths of those dear to me will mean little more than a public appearance. That life will mean no more than the frustration of a long patient list because people are sick. I am fearful that the paperwork will make someone’s death a frustratingly long form. That I will hate the form and by extension the death. I am fearful that death will make me callous. That the callousness may permeate into my everyday existence. I am fearful. I am fearful of not knowing what I should know. That I won’t have covered that one chapter of something I should know because I chose to cover something else or be somewhere else. I am fearful that I will be wrong. That it will cost someone their life. That it will affect a family, affect a friend, affect a network, affect a community. I am fearful that my failures will define me. That the Mr X that died because of my oversight will live with me forever. I am fearful. I am fearful of being perceived as incompetent. That it will define my gender and my ethnicity. I am fearful that I have ambitions in medicine. That I will achieve none. I am fearful that I see so many of my superiors without the qualities that I hoped to see in the medical field. That I will one day be them. I am fearful. I am fearful that one day my desperate sorries to loved ones will no longer be enough. That I will no longer be enough. I am fearful that suicide is becoming a reality of my life. That it could one day affect me. I am fearful of the patient who will need more than just science from me. That I won’t be able to give more than just the science. I am fearful. I am fearful that I am motivated. That it is perceived as being a novice quality. That it is useless. I am fearful that I will lose my non-medical friends. That they won’t be there when I need them the most. I am fearful that I will forget how to relax and detach. That I will never be able to let go of the medical world that is becoming my everything. Desperately fearful.

Mental health and medical students: It’s not me, it’s you. Opinion piece Imogen Janus University of Sydney III

The issue of mental health within medical students has become quite topical since I first became a medical student just over two years ago. In response, medical schools have taken many positive steps to decrease the stigma regarding mental illness and increase the resilience of their cohorts. Much of the problem seems to have been attributed to students having ‘poor coping techniques’ and ‘bad health behaviours’. The burden is then placed on them to fix the problem. Self-care is now part of the curriculum at all medical schools. As well as attending ward rounds, completing assignments, attending lectures, and studying at all other times, we are now also meant to keep in touch with social support networks, exercise regularly, eat well, engage in extra-curricular activities…. All while making sure we get enough sleep! Medical students and junior doctors now learn about ‘avoiding burnout’. But the idea of taking time for yourself seems laughable when you have 2 assignments due, a case presentation tomorrow, a presentation about falls the next day, and you need to be at your placement from 8-6 Monday to Friday. In these situations, of course I am burnt out. And it’s not because I forgot to do my breathing exercises. While mindfulness and self-care are beneficial techniques for dealing with the stresses inherent to the medical profession, there seems to be almost no recognition that so much of this problem is an environmental problem. A systemic problem. Medical students and doctors do not have high rates of suicide because they have “Type A personalities’ and need to do more yoga. These rates are due to the immense stress placed on them from day one of medical school. The world of medicine expands every day, and this means that so does the curriculum for medical students. But I don’t see much being removed from that curriculum. Students are being trained in how to cope with the increasing stresses placed on medical students, but very little action has been taken to lessen these stresses. Simple measures such as lessening the assignment load given to medical students, lessening the hours required of them, and increasing the flexibility for special consideration would have huge positive effects, I believe. Instead, the irony of setting assignments in the form of reflective essays to improve the mental health of medical students seems lost on Australia’s medical schools. If you need crisis support call Lifeline at 13 11 14

Interview with Dr Vijay Roach Interview Victoria Cook USYD IV

This article contains discussion around mental health and suicide. Vijay Roach is a consultant Obstetrics and Gynaecologist and the Vice President of RANZCOG. He is also the Chairman of the Gidget Foundation, a not-for-profit organisation promoting the importance of emotional wellbeing among expectant and new parents. Known for his openness and humility, Vijay recently address the 2018 AMSA National Leadership Development Seminar (NLDS) in Canberra. We spoke after his address about making mistakes, medical culture and his passion project the Gidget Foundation. Q. There is a lot of uncertainty in medicine and lots of students struggle with adjusting to not being able to know everything. How do you combine being comfortable with failure, yet still be confident enough to make difficult decisions? Failure needs to be defined carefully. If you studied hard and you didn’t achieve the pass mark, that’s different from failing because you didn’t put in the effort that you should have. I failed 50% of my undergraduate exams, not because it was too hard or the questions were unfair or because I wasn’t smart enough. I failed because I partied instead of studying. Simple as that! I didn’t blame anyone. I accepted the responsibility. I don’t think that one becomes comfortable with failure. There are three “A”s required in medicine: ability, affability and availability. Perfectionists only concentrate on ability, fearing that anything less than a perfect outcome is a failure. Actually perfection is unattainable. Once you realise that, the pressure is reduced significantly. Furthermore, ability can be shared – you have resources including senior colleagues, text books and the internet. Don’t take on all of the responsibility yourself. Medicine is lifelong learning. It would be conceited to think that you should know as much as your consultant.

What you can do is be diligent, dependable, consistent and trustworthy. You can be kind and compassionate. You can be caring. Most importantly, you can be there. Availability is the most important “A” because if you’re not there then it doesn’t matter how good or how nice you are. Q. As a leader in your field, you speak openly about anxiety and imposter syndrome, how do you overcome those feelings that maybe you aren’t cut out for this? Why am I sitting up at 11pm writing this? Why am I checking each word and rewriting each sentence? Because I’m a perfectionist and I worry that I’m not good enough. I’m worried that your readers won’t enjoy my writing, that I’ll let you down in some way. I worry when I give a speech that the audience will be bored. Impostor syndrome means that I’m convinced that one day I’ll be revealed as an inferior doctor, that others are more capable than I am, that my patient would have preferred an older (when I was young) or younger (now that I’m old) obstetrician. While these feelings are often there, I overcome them by taking a reality check. I am a competent surgeon. I am a knowledgeable and skilled doctor. I am a nice guy and people like me. I can give a speech and entertain an audience. In the same way that I admire and value others, I too am valued and that’s ok. Q. You are very open about burnout in your early career, and being able to take time off work when you needed it. Do you think medicine has gotten better at dealing with burnout since then, or what still needs to change? I didn’t see burnout coming. I was riding high, a successful, popular obstetrician, the flavour of the month. I was loving it, the work, the accolades, the instant gratification. But I was tired. I was

missing out. Patient first, family second, self last. I thought that the only option was to stop, to walk away, to give up medicine. In a way I did. We took the kids out of school and I employed a locum for the practice and we travelled the world for four months. I relaxed for the first time in years. We all stopped jumping every time the phone rang. We talked and laughed and read books and “wasted time”. It was wonderful. When we got back I didn’t necessarily want to go back to work but I understood that work was part of life and that I had a good job and that there were many things that I could control. I booked fewer patients, started taking weekends off and booking regular holidays. I changed my daily schedule and got more involved in teaching, charities and College work. We’re better at understanding work/life balance today. Hours are more reasonable. There are good support systems for doctors having difficulty. We’re talking about mental health and acknowledging that doctors have a problem too. My hope is that the next generation will find equal value in professional work and personal life and realise that the two can coexist if the proportions are correct. Q. You describe a career path that happened a little haphazard, that often you were sent to hospitals, rather than choosing where you wanted to work. What is your advice to students about planning for their careers? Do the early years matter that much?

The Gidget Foundation began 17 years ago when a young woman took her own life 9 months after she had a baby. She was loved by her husband, her family and friends. The baby was wanted. She had a good job. Everything was apparently ok. But “Gidget” was suffering from unrecognised postnatal depression. She hid it from everyone around her and suicide was her only way out. Gidget’s family and friends were determined to raise awareness of perinatal anxiety and depression and so the Foundation was born. It’s been a slow burn, from small gatherings to a Ladies’ Lunch for 1500 women (and me) that sells out in 12 hours. We’ve established screening programs in private hospitals, offer face to face and telehealth psychology services, have a national presence and are now recognised as the leading consumer voice in perinatal mental health. There are more than 54,000 registered charities in Australia. Ask yourself whether you should be working with one of them before you create your own. It doesn’t happen overnight. If your passionate about a cause, find a mentor and don’t reinvent the wheel. If you want to do it remember that volunteer work requires more commitment than employed work. The motivation is passion and the reward can be a sense of purpose and the opportunity to help your community. It’s worth it but you don’t have to do it alone. If you need crisis support call Lifeline at 13 11 14

This is a common question! My answer may be counterintuitive. Do what you enjoy. Rather than seeking to gain an advantage for an uncertain outcome, realise that you are inexperienced and that you don’t know what you don’t know. Your exposure to specialities is limited as a student. Choose your hospital for its culture, its location, because it offers you terms that you think will be stimulating or interesting next year, not because it will set you up for the future. It may not, and if you’ve invested too much and you’re not having a good time, that would be a pity. Q. You are the chair of the Gidget Foundation and started helped start this program from scratch. What would you say to students about starting their own organisation, what are the key ingredients of a successful organisation?

Kalgoorlie Super Pit Artwork Sylvia Rienks University of Notre Dame Freemantle III I’ve had a long absence from painting, and only just started up again. Medicine is a world of preciseness and perfectionism, so sometimes it’s good to paint and know that making mistakes is all part of the process. It’s a way of practicing acceptance that I’m a human being.

Wounded Healers Reflection Charlotte Krones University of Notre Dame I This article contains discussion around mental health and suicide. Most of us have been affected by suicide in some way or another. Whether it was someone at school, university or work, a friend or a family member, death by suicide is common and can have devastating effects on families, friends and communities involved. It is all too often that it is the silent elephant lurking in the corner of the room. Recently my dad sent an article “Wounded Healers” from The Australian to my family (who are all doctors or striving to be) which discussed the high suicide rates among physicians. It was only that morning that I had been chatting with other medical students about whether we can reflect on our own mental health experiences or whether this might be held against us one day if we do make some form of mistake. There was a belief amongst some students that even getting a mental health care plan from a GP could one day be used against us. Could this be true? Surely not, getting help is surely a sign of strength, resilience and a path to better health. The suicide rate among doctors is much higher than that of the general population (Glaser, 2015). Which might not be surprising as doctors are under enormous pressure. A simple mistake could cost a patient’s life. The military, a profession with equally high stakes, does not have as high suicide rates (Anderson, 2018). Why is that? Is it the stigma involved? The mandatory reporting of doctors who are psychologically unwell? As a firstyear medical student, who has had my own battles and has lost friends and community members to suicide growing up, I can’t bear to think that I will inevitably lose someone to suicide again. I feel scared, not only for myself but also my fellow students, friends and family of doctors. Have we got what it takes to withstand the pressure? And if we don’t, does our industry have the support structures in place to allow us to ask for help when we need it? The wounded healer hypothesis, postulates that individuals who are attracted to the field of

medicine possess traits like altruism, empathy and sensitivity to the pain of others, which will ultimately help them excel in the medical field. Yet this sensitivity, mixed with a sometimes-unhealthy dose of perfectionism, in an environment that is incredibly stressful, incredibly demanding and often deals with death on a day to day basis can be to our detriment. Within the article that my dad sent me, Doctor Geoffrey Toogood reflected on his bout of crippling depression, fueled by both personal and work stressors. He has recovered now, but reflects bitterly on the culture of his workplace, where he felt shunned and perceived as weak. How is it possible that we learn to care for our patients, encourage our patients to look after their mental health, yet more often than not, colleagues feel as though they can’t even talk about their experiences to their colleagues. The media is reporting suicide amongst doctors more and more. I am hopeful that as we progress through our careers that the mental health stigma will slowly be stamped out. Moving through my career I hope to support my fellow colleagues, friends and family. We prescribe self-care to our patients, I believe` it’s time we start prescribing it to ourselves too. If you need crisis support call Lifeline at 13 11 14 References: Anderson, P. (2018, May 7). Physicians experience highest suicide rate of any profession. Medscape, Retrieved from https://www.medscape.com/viewarticle/896257. Beyond Blue (2013, October 8). Urgent action needed to improve the mental health and save lives of Australian doctors and medical students [Press release]. Retrieved from https://www.beyondblue.org.au/docs/defaultsource/media-release-pdf/urgent-action-needed-toimprove-the-mental-health-and-save-the-lives-ofaustralian-doctors-and-medical-students-october-2013. pdf?sfvrsn=6eae79ea_0. Glaser, G. (2015). Unfortunately, doctors are pretty good at suicide. Journal of Medicine. ncnp. org/journal-ofmedicine/1601-unfortunately-doctors-are-pretty-good-atsuicide. html. Published August, 24. Verghis, S. (2018, May 5). Wounded healers. The Australian, Retrieved from https://www.theaustralian.com.au/life/ weekend-australian-magazine/why-is-suicide-rife-in-themedical-profession/news-story/3b47136045d24ad884996 6fc98cc4599.

The Colour

To All

In My Life

Photography Jessica Yang WSU IV

Perspective

How we see something becomes our truth Thaddeus McFarlane Griffith University II

The P word. Perspective, defined as ‘a particular attitude towards or way of regarding something; a point of view.’ This word is my favourite word. Why you may ask? Because your perspective changes the way you think about the word and it doesn’t stop there, your perspective changes the way you think about the world! The world we live in is truly an amazing place. With wonders at every turn along with a myriad of things we can’t possibly understand. I often find myself looking out at the world around me, completely perplexed as to how and why I have come to be in the position I am in. Being able to follow my dream, work and study in the most beautiful place in the world constantly reminds me of how blessed I am. I wake up every morning,

rub the sleepiness from my eyes and am truly thankful for the opportunities I have been given in life. I truly love life and couldn’t be more positive about the future of my life and the people’s lives around me! People often ask me, “Thady, how are you so positive and how do you manage to do so much?”, I just say the P word. And it’s a word I would love for you all to take on board, even just a little bit. I will share some tips and examples with you of how I learned to mould my thinking to be more positive and think through my actions, along with the world around me.

Lessons are everywhere, it’s on you to find them Everyone around you knows something you don’t, so why not go ask them? Taking charge of your growth as a person is on you. Looking for opportunities is on you. Exploring and focusing on the little things around you is on you. “Growth is the result of how you utilize the people around you, and create opportunities for yourself. “ – Nicholas Cole Nothing lasts forever Life has its up and downs, But most important to remember is that, just like a rollercoaster, everything comes to an end. That long lecture will eventually end, the exam week will end, the feeling of loss after a break up will end. Stopping during these times and realising that the end will come and changing your perspective will be a great help at these times. There is a Jewish folktale that focuses on the concept of impermanence. It starts with King Solomon who asks his finest men to go and find him a ring that will make a joyful wearer forget his joy, and a broken hearted wearer forget his sorry. King Solomon did not believe that such a ring existed, but wanted to teach his men humility. Eventually the men found a ring inscribed with three Hebrew letters, “Gam zeh ya’avor” which means “This too shall pass.” This sentiment embodies the idea that everything will end. A positive perspective to take from this story is that whilst the good times will eventually be over, so too will the bad.

you do better for the future. Instead of focusing on WHY an event happened, focus on WHAT you can do to prevent it happening in the future. Perhaps you need to change your study patterns, or ask for help. The important thing to remember is that you must learn from everything that happens to you. This will cultivate your perspective of life to be more positive by focusing on the things you can do for the future, rather than the things you things you have failed at in the past. There is more to life than med school I cannot reiterate this enough! Medical school is a huge part of your life at the moment but it is only one part of who you are. Filling your brain with facts is great but if you don’t give your brain a break, it will eventually get tired and not work as effectively, a bit like a car that doesn’t get serviced. It is more beneficial for you to take a break for an hour so that you can work at 100% again, than to continually work at 60%. Get out into the community and find a way to serve others. Service teaches us humility and respect, especially when that service is for free. “Instead of complaining that the rose bush is full of thorns, be happy the thorn bush has roses.” ~Proverb “The world is what you make it, and you see it how you want to see it.”

External vs. Internal Explanations There a plethora of reasons why a single event happens, and a million more ways in which we can appraise it. It’s important to acknowledge the multiple factors that can contribute to a situation and not just blame one factor. For example, you did not do well in an exam that you thought you would do well in. An external explanation would be that the test was too hard and the lecturer was trying to trick you; an internal explanation could be that you feel you’re not smart enough for the course and conclude that you are “dumb”. Ultimately, both these explanations will not help

Dear Past Self Reflection Yun Megan Foo Western Sydney University IV

Dear Past Self, It is the last night of NewGHC 2016. You are sitting with the rest of #socialsquad, surrounded by tassels and other half-done decorations. Everyone is smiling and laughing, one half exhausted and one half relieved. One more event and then we’re almost done. Jim and Jessey, the social convenors, are welcoming and kind, and they give you a beautiful notebook and a tiny bottle of champagne, thanks for all the hard work you and the team have put in over the past few months. You accept it gratefully, but inside you feel the deep pit of disappointment. You know that you have not done enough. My first involvement as an AMSA volunteer was as a member of the social subcommittee for the 2016 Newcastle GHC. After the fun as a delegate at Convention M15, I was pumped to do more. Despite my minimal experience, the social team took me in, and I became part of the #socialsquad. For the first meeting, I was on holidays so I took the 2.5h train ride to Newcastle, met the team in person and got all excited! Next meeting? Too busy to travel, I’ll just call in. Technology problems? Oh well, I’ll just read the minutes. Tasks to do? I have months, it’ll get sorted before then. Before I knew it, it was time for NewGHC and I had not done my job. The rest of the team had covered where I had fallen short, finding venues I was allocated to and ordering decorations I was meant to find. I had no idea about the big picture and just did whatever I was told. I was an extra pair of helping hands, but what the socialsquad really needed, was a member of the team. At the end of it all, everyone still treated me nicely, but I knew that I had let them down. It was a terrible feeling, and I never wanted to feel it again. Despite the mistakes I made, I was lucky enough to have the opportunity to do more in AMSA. Learning from my failures, I went on to give my all in SYD17 Academics and Crossing Borders. I

attended meetings, worked on my action items, replied emails promptly, took initiative wherever I could. I had learnt what it meant to be a volunteer, in particular an AMSA volunteer. Getting involved is such a wonderful experience, and the more you put in, the more you get out. Between all that, my friend Phoebe and I put in a bid for NLDS18 and were selected as the Co-Convenors. In our bid letter, we wrote out all the AMSA roles I had held, which demonstrated “varied experience in event organisation and team communication”. At NLDS, supposedly full of experience, I made more mistakes. I learnt that no matter how time-poor you are, it is never too little time to say please and thank you. While you are keen to do everything, never over-commit. Communicate clearly, especially when other peoples’ hard work depends on it. I am writing this letter to you soon after the wrapup of an incredible NLDS. On the last day, Jack, the NewGHC 2016 Deputy, pulls you in for a hug and tells you that he would never have imagined the person he met at NewGHC becoming the person you are today, congratulations on an awesome event. You tell him that you never imagined it too, especially after you stuffed up at NewGHC. Mistakes are opportunities to learn, and I know you’ll keep on learning. It’s okay if you stumble, so long as you identify it, apologise, and make sure to try again. With all my love, Your Future Self p.s. when doing the catering, more people than you realise will drink soy milk p.p.s remember your receipts p.p.p.s don’t forget your handover, so others can learn too

Medical Students Are Sick of the Government Harming Refugees in Detention Opinion Piece Originally published in Doctus project Carrie Lee UNSW V

To all the medical students of Australia Thank you very much for your solidarities & support Youâ&#x20AC;&#x2122;re the future doctors of Australia & world Much love from the refugees on #Manus & #Nauru -Aziz @ManusAlert

Photo credit: Rhonda Ung

Photo credit: Rhonda Ung Medical students are not the first to speak out against detention and we will not be the last. On April 8th, over 400 medical students, doctors and community members marched through the streets of Sydney, united by a shared refusal to accept the mistreatment of refugees on Manus Island and Nauru. We marched because it is unconscionable to deny people access to basic health care, and worse, deliberately put them in harm’s way, to send a political message. We marched because we refuse to neglect our duty of care for the men, women and children seeking asylum in Australia – as is their legal right. The #DetentionHarmsHealth march was born out of a conversation between medical student Kevin Chan and whistleblower nurse Alanna Maycock who spoke out against detention after witnessing the cruelties on Nauru. The idea garnered attention of medical students across New South Wales and other states. Last November, the Australian Medical Students’ Association (AMSA) reacted to the crisis on Manus Island when the government-run facilities were closed. We penned letters to the Department of Home Affairs expressing concern for the health and safety of these men, forcibly moved to alternative accommodation. We asked for reassurance they would receive adequate healthcare.

The government denied responsibility. “The management of refugees and those found not to be refugees are matters for PNG authorities,” read the Department’s chilling reply. The irony is that for years, Australian politicians have slow-clapped themselves for “stopping the boats”. As if they have compassionately saved people from drowning at sea by slowly torturing them in detention. Let us be clear: there is no compassion in this. Australia’s offshore detention policies are a toxic labyrinth of secrecy, distraction, and human rights abuses perpetrated against a highly vulnerable population. Refugees have experienced trauma due to conflict, persecution, and loss of loved ones. Many have physical and mental health conditions which have often gone untreated due to a lack of access to medical care. Yet these people are detained indefinitely in unsafe, unsanitary conditions on Manus Island and Nauru. Leaked files from Manus Island and Nauru document countless incidents of abuse, medical negligence and violence – including by government-employed staff. Half of these incidents involved children. In recent months, three pre-teenage children have been evacuated from Nauru to Australia

for psychiatric treatment because their despair reached suicidal levels. Worse, our government attempted to block their medical transfer – even against urgent recommendations from doctors. These young children know Australia’s detention policies are fundamentally wrong. Filmed in his humid tent on Nauru, 12-year old asylum seeker Ali made an emotional plea for his severely depressed mother to be brought to Australia for treatment. “They are trying to kill us little by little,” he said, poignantly capturing the psychological distress of detention. “They made my mum sick. They made my brother sick. They want to kill me with torture.” These policies equate to torture, as condemned by United Nations. But it is even more heartwrenching to hear this from a child forced to grapple with such senseless cruelty. This isn’t the first time the government denied essential healthcare to refugees in offshore detention. Eight men held in detention have lost their lives on Manus Island and Nauru since 2010. In 2014, Iranian refugee Hamid Kehazaei died from a cut to his leg that turned into overwhelming sepsis; in 2016, Omid Masoumali died from self-immolation burns. Both succumbed to complications that could have been treated had they received timely medical care, blocked by unnecessary bureaucratic delays.

Photo credit: Rhonda Ung

Government-contracted health provider IHMS on Manus Island and Nauru has barely been a bandaid for the health of refugees. Operating from bare-bones clinics, they have scarce psychiatric or chronic disease treatments, leaving seriously ill people to seek treatment overseas. With IHMS’s contract ending at the end of April with no clear plan for the near future, the situation is deteriorating further. This is our national shame. After years of our government ignoring condemnation from medical professionals and international agencies, many Australians have grown disillusioned that this situation will never change. Now more than ever, we need to keep bringing the focus back to health and humanitarian issues, not politics. Indeed, advocacy organisations are building pressure, and media has renewed their focus on this debate. Now one of the most powerful harbingers of change is the Labor party’s promise for a change in offshore detention policies. Australia could follow Canada’s lead with humane alternatives to detention, such as communitysponsored resettlement programs. So watch this space: the Australian community is holding our government accountable. As long as people - especially young people - speak up, there is hope for change. We, as Australian medical students, will be watching.

Vampire Cup Project Recap Olivia Ferry Vampire Cup Project Coordinator University of Queensland IV

The 2018 AMSA Vampire Cup has just concluded after eight weeks of fierce competition. The results are in and the 2018 Vampire Cup is officially the largest in history with over 3000 donations in total nation wide! This is 650 more donations than 2017! This incredible effort is due to our amazing Vampire Cup coordinators across the country with many Universities setting their own donation

records. The bloody champions of 2018 are the Australian National University who record their third Vampire Cup win in as many years with 71.5% of their cohort rolling up their sleeves. While James Cook University has set a new standard winning the title of most donations with 426 donations to their name. A fantastic effort coming from last place in 2017 to record the largest ever donation total by a single university in Vampire Cup history (an 800% annual improvement).

This year has also seen more new donors than ever before with 571 students rolling up their sleeves for the first time. After moving the competition forward three months this year, we have answered the call from the Red Cross Blood Service to increase critical blood stocks prior to the winter period. However, Vampire Cup has two goals, to increase blood donation and to promote the importance of donation in the community. We believe we have succeeded in 2018 not just in increasing donations but by spreading the message of blood donation far and wide. The 2018 Vampire Cup has graced the screens of live ABC breakfast television, the Brisbane airwaves of morning radio and local newspapers across the country. This year the theme of Vampire Cup was centred on where your blood donation goes and the recipients of blood products. We heard from medical students who receive blood themselves and from those with family members whose lives have been saved or irreversibly transformed thanks to blood donors. Your blood is anotherâ&#x20AC;&#x2122;s lifeline. So who will you save?

NLDS Event Recap Phoebe Macintosh-Evans, Yun Megan Foo NLDS Co-Convenors UNSW, WSU IV Making mistakes is a curious concept. As a culture, medicine and by extension medical students strive to never make a mistake. And yet, we often do. AMSA’s National Leadership Development Seminar is the first event that kicks off the events calendar for the year, and we have been so honoured to be a part of it. From May 19-23rd, approximately one hundred medical students gathered in the heart of our nation’s capital. Over the five days, our delegates explored issues at the forefront of the Australian and global context. They heard from amazing speakers who were at the pinnacle of their field, and incredible presenters who were students only a few years ago. If they were interested, they got the unique opportunity to meet with their MP in Parliament House, and discuss the issues they felt passionately about. They presented their projects in Old Parliament House, and two (maybe more!) groups are now getting their ideas integrated with AMSA Central Projects. Between all that, they got to enjoy some fantastic socials and meet with each other, hopefully forming connections that will be valued for years to come.

We met at NLDS 2016, on the bus from Sydney to Canberra. We were both in second year, with not much experience under our belts, and we were spellbound. Ian McConnell-Whalan was the

NLDS Convenor in our year, leading a team of superstar portfolio holders. Sitting lecture-style on the very first day, we listened enraptured as Ian gave his opening address. Despite the struggle with a double-dissolution happening in parliament that year, the whole event still went brilliantly, and at the end of it all we were inspired to keep doing more in AMSA and our MedSocs. However, we never thought that we would ever be in Ian’s shoes. Fast forward two years, and we won the bid to co-convene NLDS18. To prepare, we consulted with nearly every single role-holder from the past three teams. We drew from our own experiences on Medsoc and AMSA executives and on event subcommittees. We remembered our time at our own NLDS. We still made mistakes. We are fortunate that our mistakes remained unknown to our delegates, and the event still went smoothly. Behind the curtain, there were hurried venue negotiations, stressful midnight debriefs, and too many frantic phone calls. Unpredicted issues popped up, predicted issues popped up, and as much as we prepared there was always more to do. Over the course of putting this event together, a lot of what we have learnt as a team, as convenors, and finally as leaders, is that mistakes do happen. Leadership is about identifying them, then doing something about it. It is recognising that leadership is not perfect, and practicing the humility that comes with that. It is about taking responsibility, and looking out for each other. Finally, it is about forgiveness, and building up the courage to try again. We would like to thank our NLDS Team – Kelly, Jacinta, Stef, Sarah B, Connor, Andy, Rhea, Sarah M. Thank you for putting in your all, for being a part of the journey with us. Thank you for covering when we made mistakes. NLDS18 would not have been possible without you. Yours in orange, Phoebe and Megan NLDS18 Co-Convenors

Donâ&#x20AC;&#x2122;t Le ave Yo ur Career To Fort une

The AMA Career Advice Service, however, seriously understands the profession and its challenges. It can help you prepare for your post-graduation years. It will assist YOU to achieve your goals by providing you with advice and support on: l

Surviving medical school and your intern year

Looking after yourself

Building and maintaining a current and relevant CV

Addressing selection criteria

Preparing for and performance at interview

For more information contact: Anita Fletcher (Career Adviser) careers@ama.com.au Career Advice Hub: ama.com.au/careers/ Career Counselling: careers@ama.com.au

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