Panacea Volume 52 Issue 2 by The Australian Medical Students' Association

Contents As medical students, we encounter situations where we need to discover our voice. In the clinical setting, it may be finding the right questions to ask to arrive at a diagnosis, or choosing the words to say to a patient who had received bad news. Outside of medicine, it may be finding our voice and establishing our identity through music, performance, writing and so many other hobbies. As individuals and as a student body, we also have the voice and power to advocate for issues impacting the health of a population, such as climate change and mandatory detention. This issue of Panacea hopes to explore these areas and to encourage students to take a step forward towards finding an honest, authentic voice.

MChD or Busk

Sowing the Seeds for Future Health

Using Your Voice, and Singing Loudly

Finding Your Medical Voice

Jonathan McGuane

Katherine Middleton

Cathryn Youings

Stephanie Pommerel

Enactment 10 David Athan

Finding Your Voice in Open Disclosure

Crossing Borders Speech at GHC

Jess Yang In Conversation with Gender Equity

Soon Weâ&#x20AC;&#x2122;ll All be Dead

From the Convention Convenor

From the GHC Convenors

Sarah Keenan

Adele Evans

Jessie Zhang and Jess Yang

Ravi Naran

Sid Narula

Alice Mizrahi and Gowri Shivasabesan

MChD or Busk Jonathan McGuane Australian National Univeristy III

It was a beautiful summer day in Canberra, and I had been performing reconnaissance of the outdoor shopping strip for an hour or so – assessing patterns of migration, levels of foot traffic, the degree of solar exposure, and proximity to seated patrons from various vantage points. The requisite equipment was in the parked car nearby, along with welldocumented plans in a blue folder, and yet I couldn’t bring myself to execute them. I had been preparing for this moment my entire life, but I was paralysed with fear. I texted my wife: I can’t do it. I’m too scared. She replied: You’ll be great. You’ve sounded fantastic of late. Just do a few songs and then come home. And despite these words of encouragement, I eventually left, having failed to achieve what I had set out to do. I got in the car, went to my son’s school, waited for him to finish, and drove us both home. This was my second attempt at busking in public. I was midway through my medical degree and trying to earn some extra cash to supplement the family income over the study break. Although I knew in myself I was capable, getting up the courage to start was proving impossible. Why couldn’t I do this? I don’t have a lot of early childhood memories, but of those that exist, listening to and making music feature in a fairly high proportion of them: Lying on the floor with the single cassette deck/radio player that normally lived on the kitchen bench, one ear pressed tightly against the speaker (I had conductive hearing loss as a child); squeezing behind the piano to listen as my brother practiced (great acoustics; nice and loud); and singing on the

back of a truck with my eight older siblings at the local Carols by Candlelight. Music was my favourite lesson at our tiny primary school in regional Victoria, and the hymns we sang every Sunday at church were the highlight in what was otherwise a pretty boring weekly ritual. Around age 9 I started learning piano under the tutelage of the sweetest little old lady – appropriately named Dulcie – that you could imagine, and once at high school I took up guitar too. I featured in the cast or band of every high school musical, played piano for the school jazz band, and studied music (piano) in VCE years (although I was never a brilliant pianist and probably should have concentrated on my first love, singing). I even regularly used to pull out my guitar on the 50 minute school bus ride to and from home, and give my fellow riders an intimate performance of the latest songs I had learnt. Sometime in these formative years though, my passion for performing was lost. In the maelstrom of puberty and the attendant thrall of hormones, trying to discover my independent identity but simultaneously desperate to fit in, I became introspective and self-doubting, with an anaemia of confidence and essentially unable to communicate with people I didn’t know well. Looking back, I think I basically became sick of not being good at the things it was more important to be good at in a country town in the 90’s, like footy and cricket, and so stopped putting myself and what I had to offer the world out there. What I did take away instead was an expertlevel ability to suppress that angst and adopt a façade of self-esteem that wasn’t really there. So I went off to uni, studied biological 1

science and did well enough, and in 1999, met a beautiful girl who had just started at the coastal resort I worked at during the holidays. Soon after, there was a staff karaoke function at which I sang Wet Wet Wet’s “Love Is All Around” to her (soppy, I know). Our relationship developed, and she has believed in me so strongly over the years that she moved overseas with me, then back to Australia (but not our home state), and now to the ACT with two kids in tow so that I can pursue my medical dream of a better life for our little family. And she loves my voice. It was her that came to my rescue, physically sitting beside me so I could get over my crisis of confidence and properly busk for the first time (I made $9). The next time I went out, I was approached by a listener who offered me a gig, and I’ve since performed several times there, and at a club in Goulburn where currently I’m on long term rural placement.

words to describe the deep-seated desire to perform other than it’s an expression of my soul. While not everyone will appreciate what I do and that’s fine, I’ve come to realise its importance to my psychological health. Functional MRI studies have shown – unsurprisingly perhaps – that music activates the dopaminergic reward pathways in the CNS, and for many including myself, making and listening to music is a deeply pleasurable experience. Last week I picked up a harmonica and accompanied myself on guitar for the first time, and I could almost feel the dopamine-containing vesicles exocytosing into the striatal synapses. So, my prescription for finding your voice: find that thing that releases your dopamine and repeat PRN. The tricky part can be working up the courage, and I’ll be forever grateful to my wife for helping me do that. I don’t intend to be silent again any time soon.

I’m not a spiritual person, and despite lacking belief in the concept per se, I can’t find better

Sowing the Seeds for Future Health Katherine Middleton University of Western Australia II

From my personal experience, farmers work harder than any other people I know. It’s a controversial statement, especially as a medical student, but I stand by it. I’m a rural kid. I grew up on a tiny property by most standards, 450km north of Perth. My first job was as a fruit picker on the neighbour’s farm. During summer, my brother and I would wake up at 5am to head to the farm and start picking before the heat really kicked in. When we arrived, our neighbour would have normally have been there for at least an hour, checking crop, equipment, setting up for the day. We’d normally finish just before midday, and while the kids would head straight for the beach, our boss would keep working. We’d sometimes drive into town for the afternoon, and I remember driving past their property seeing him out in the fields, still working, checking watering systems. It wasn’t a job, it was their entire life.

had enough, or it’s come at the wrong time. I often felt as if there wasn’t much I could do about what my friends and family were going through. I mean I am just a medical student. I learnt about how droughts manifest within the scope of a future health professional— heat strokes, mental health, food security. As I became more concerned, I went out of my way to learn more, to try and figure out what I—as a medical student—could do about it. As future doctors, we were going to have a role in healing our patients and preventing future illness. But with a planet already so sick, looking down the barrel of a transfer to ICU, what kind of preventative measures could I take to divert this deterioration. But then, I am a medical student. There was no “just” about it.

Growing up, the livelihood of the people surrounding me depended on the land. In the background of nearly all of my memories of my childhood are straw-coloured fields, characteristic of the wheatbelt I grew up in.

A month ago, the Australian Medical Students Association announced its decision to divest from fossil fuels. In doing so, AMSA is taking action to take care of our environment, to take care of health. As a collective, the medical students of Australia found our voice.

I moved to the city for my medical degree, but I didn’t leave my rural roots behind me. Attending residential college, most of my friends were farmers’ kids. Weather was a staple in terms of mealtime conversation— not for lack of social skills or originality, but because rainfall around the state was important to everyone’s family and friends. And the common message of nearly all of these conversations is this: we’ve either not

The contribution of fossil fuels to climate change is undeniable. Put very simply, the burning of fossil fuels emits green house gases, including carbon dioxide, and this traps heat within the atmosphere, contributing to global warming.1 This change in our climate gives rise to an increase in frequency and severity of extreme weather events, such as storms and floods, fatal heat waves and droughts. Warmer temperatures can 3

amplify the impacts of drought. Increased temperatures enhances evaporation from soil, which makes droughts more severe by way of positive feedback . On top of its contribution to climate change, burning fossil fuels also pollutes the air, by the emission of particulates. The burning of fossil fuels directly contributes to air pollution that causes 7 million deaths per year worldwide, a figure that is predicted to continue to increase if no action is taken.2 Its because of this that climate change is a health issue. AMSA divesting is our version of secondary prevention. Our earth is already afflicted with global warming, and divestment was the measure we were taking to decrease its severity, shorten the course of the illness an prevent further complications. Divestment is dis-investment—the opposite of investment. Its an advocacy tool that involves removing assets with industries or companies whose values do not align with the priorities of your organisation. In doing so, foremost, it diverts money away from morally, politically or environmentally problematic industries, and diverts it towards ethical and sustainable alternatives. By reducing the profitability of harmful business practices, divestment puts financial pressure on target stakeholders to improve these practices, or undermines their financial viability. Plus, it ensures money is invested in organisations engaging in ethical and sustainable practices. Secondly, divestment helps to remove the ‘social licence’ of problem industries and organisations. Divesting from an industry or organisation is a clear public statement of disapproval.3 In 2009 The Lancet described climate change as the biggest global health threat of the 21st century, and it is widely accepted that the burning of fossil fuels (coal, oil and gas) is the greatest contributor to this .4 In the same way health professional were advocates for tobacco divestment, we must take a stance on fossil fuels, because continued support

for investment in this sector is arguably deplorable and at odds with our responsibility to protect health.5 If we consider the planet as one of our patients, right now, we’re leading by example in terms of patient advocacy. AMSA represents 18,000 medical students. By putting all our voices together, we’ve amplified the call for change. If the planet were a patient, we’d be going be busting our guts to improve its condition, improve its health. But the planet is impacting on our patient’s health, and continuing to do harm to our planet harms our patients too. Collectively, medical students, as recognised leaders in the community, health professionals have become advocates for action on climate change, to alleviate its impacts on health. This is my way—this is our way—of helping my family, friends, neighbours and future patients, improving their health and the health of the planet. References 1. Höök M, Tang X. Depletion of fossil fuels and anthropogenic climate change—A review. Energy Policy. 2013;52:797-809. 2. Thurston G. Air pollution, human health, climate change and you. Thorax [10.1136/ thx.2007.079228]. 2007;62(9):748. 3. Apfel DC. Exploring divestment as a strategy for change: An evaluation of the history, success, and challenges of fossil fuel divestment. Social Research: An International Quarterly. 2015;82(4):913-937. 4. Costello A, Abbas M, Allen A, Ball S, Bell S, Bellamy R, et al. Managing the health effects of climate change: lancet and University College London Institute for Global Health Commission. The Lancet. 2009;373(9676):1693-1733. 5. McDaniel PA, Smith EA, Malone RE. Philip Morris’s Project Sunrise: weakening tobacco control by working with it. Tobacco control. 2006;15(3):215-223.

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

Using Your Voice, and Singing Loudly Cathryn Youings Australian National University III I have always found a singular joy in music. There is a versatility in music that allows such breadth of engagement with the artform. One can listen intently or allow it to morph into their background. Music can be practiced in a group, or on oneâ&#x20AC;&#x2122;s own, in front of others or just in their own solitary bliss. To me, music can be an amalgamation of pleasure and bravery. I joined my first choir when I was five and immediately loved the joy making music with my own voice rather than listening to others and that of the radio. I loved the social aspect of choir and I loved being part of a team. Singing to me was a release and learning new skills and new songs was an achievement. However, to sing, one must be brave. I remember standing alone on stage for the first time, lights obstructing your view, warming your face in an uncomfortable rush, you hear the introduction begin before you start singing and suddenly you cannot swallow. I have always found the four beats before opening my mouth the most difficult. You go into fight or flight mode. Do I stay here and sing what I have rehearsed for months or do I run away now, for fear of failing, being laughed at or simply not being as good as another? You breathe, allow oxygen and reason to sustain you and start your piece. This exact moment is when the fear and self-doubt ebbs away. You can almost physically feel the coiling of your muscles and overdrive of your

mind dissipate away from your being and equilibrium is found once more. The stark contrast from fight or flight to pure relaxation and delight is dizzying. Suddenly the lights in your eyes mirror the enlightenment of your soul and the warmth on your face is soothing and homely. The joy that was before momentarily forgotten comes back in a fierce wave, all due to being brave. I find some of these feelings similar in being a medical student. The feeling of the spotlight on you to answer a question or make a decision can be uncomfortable and offputting. The fear of being judged or looking daft in a sea of over-achieving peers where we wish to belong can be overwhelming. But then the breath comes again, and the clinical reasoning, the confidence, the ability to learn and the ability to identify and rectify weakness. This is part of the joy of medicine to me. Music is applicable in all our day to day lives. The enjoyment and emotions that its stirs in us are crucial to being well rounded and to have individual growth. The skills gained in practicing music is something that I have utilised in all aspects of my life. That can be having a go at a question or speaking confidently, or just in the process of making new connections with people. Singing has allowed me to find my voice, and by singing loudly, and proudly I have formed an identity along with it.

Finding Your Medical Voice Stephanie Pommerel University of Queensland IV

“Tell me, why you have come here today?” When a patient presents to you for medical attention, one of the first questions we aim to elicit an answer for is why they are here. What has brought them to see us, and why? Why now? What ensues is a story. Our job is to make medical sense of that story. Often we are provided with details that may seem extraneous. But the key to connecting with our patients is in those details. It’s the things we pick up on that make all the difference to the patient feeling heard.

but without speaking to the person. It can make patients feel uncomfortable to be so closely inspected by many students at once, but it certainly was a useful lesson in clinical and diagnostic reasoning. Sir Osler himself made a broad scientific approach into an artform, using his powers of observation and engaging with patients to gain an indepth understanding of the whole person, and demonstrated more care for the human being before him than the disease (Seeman & Becker, 2017).

As part of history taking, we learn to start with open-ended questions. Open-ended questions lead to unscripted answers. The patient begins to tell their story which in many cases, has started years before. Be prepared to settle in for an in-depth conversation, even though you may not have time.

Effective and efficient history taking is a key required to unlock the door to diagnosis. In medicine, histories follow a formula. Communication proceeds from face-to-face with the patient, into written notes, and is also relayed in person to colleagues. Thus, we must first record the date and time of our interview. Demographics are important to contextualize the person we are seeing in terms of gender, age and occupation, which can stratify according to epidemiology and risk factors. Then, the presenting complaint is heard, first in the patients’ words.The history of that complaint is then enquired into: when did it start? What else has been going on? We get specific.

“Just listen to your patient, he is telling you the diagnosis” Sir William Osler (1849–1919) Sir William Osler was a renowned physician and natural scientist whose wealth of understanding in medicine gave rise to many published books and articles. A contemporary of Sir Charles Darwin, he taught that regardless of one’s own experience with medicine, much is to be learnt at the bedside, from observing and speaking with patients (Seeman & Becker, 2017). Indeed, on one placement in Emergency, Associate Professor Wayne Hazell instructed us to conduct an end-of-the-bed-ogram for each patient in the department, the purpose being to see which we were most concerned about, using our full powers of observation

Mneumonics can guide us, particularly with pain histories. NILDOCAAFIAT stands for nature, intensity, location, duration, onset, concomitant, alleviating, aggravating, frequency, impact, attribute, and treatment. Others include SOCRATES and PQRST (Google them). SAMPLE is an acute history tool that gathers signs/symptoms, allergies, medications, past medical history, last meal, and events leading up to the 7

presenting illness. ISBAR is used in clinical handover, with an introduction and outline of the situation followed by background, assessment and recommendation. Picking these apart, we aim to get as comprehensive a picture of the health of that particular patient and how the presenting complaint is affecting them. We need to see this clearly for us to be able to begin the process of diagnosis. We then screen for red flags and risk factors. The person’s past medical and surgical history, and context of their family’s health can be important in many cases, but the latter can become less important at times in the elderly population. However of crucial importance is the patient’s medication and allergies, which must be acquired at each initial consultation. Medications can not only guide us as to past history in the nonverbal patient or where communication is a challenge, but can point further towards diagnosis. Though we must practice and find our own expression within the formula, Osler would counsel us not to lose our patients through routine repetition of a tired script (Seeman & Becker, 2017). There is no easier way to alienate ourselves and our profession from patients. And, there is no greater curse than not hearing what the patient has told us. To listen intently is to hear a patient as they describe the impact of illness on their life, and gives their presentation context and meaning. People know when they are not truly being heard. A patient-centred approach leads to greater satisfaction for both doctors and patients (Ha & Longnecker, 2010). Such focus on the humanity of our patients can be the foundation from which medicine evolves, if we but allow it (Seeman & Becker, 2017). Our observation and interview, together of course with clinical examination, guide not only our differential diagnoses but initial treatment and management. Patient engagement also intrinsically hinges on our own approach, and offers healing in and of

itself (Barker, 2018). This is the foundation of therapeutic relationship. In the words of one of my previous medical registrars, Dr Dougal Smith, “Always remember your presence in the room”. Our presence can contribute to patients’ healing process, or be detrimental to it. Non-verbal communication carries more of a message than do our words. Aspects of this unstoppable method of communication include eye contact, posture, gestures and tone of voice, as well as manipulation of the physical environment, such as the positioning of chairs in a consultation space (Vogel, Meyer & Harendza, 2018). Mehrabian and Ferris calculated that 55% of the total impact of communication comes from facial expression, 38% from vocal attributes and just 7% from the words themselves (in Vogel, et al, 2018). Thus, as students, it is worth attending to ourselves to become aware of what we are communicating with our bodies. To paraphrase another mentor, Dr Ralph McConaghy: Don’t hide behind your notes or folders as you approach patients on ward rounds or as a student. Be with them in full humanity – ready to listen, understand, spend time, share your knowledge, and allow yourself to be touched deeply by their story (Seeman & Becker, 2017). One of the greatest and most valued skills in medicine is supportive psychotherapy (Seeman & Becker, 2017). Frequently presenting with psychological distress, our patients seek to answer questions arising about their health and within this space, we are asked to find our voice (Warnecke, 2014). We can convey far more compassion with an intent ear and heart open to the significance of the events leading to that particular person’s presentation, than a narrowed focus on pure disease mechanics alone. Medicine is, of course, grounded in physiology but it does not explain to a person why they have acquired ill-health. This requires sensitivity and care in discussion. In Osler’s own words: “Variability is the law of life, and as no two faces are the same, 8

so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as diseaseâ&#x20AC;? (Seeman & Becker, 2017). So whilst we of course must study the disease processes, I personally have found lessons far more grounding when narrated by a patient. The other thing to note is not to let another cull your own attempts to find your voice in medicine. No two doctors express the same way; indeed, no two human beings do. Each of us has a particular aspect or catalogue of experience that places us in a unique position to communicate to each other through medicine. Finding your unique voice in medicine is a journey for you to discover alone, guided though you may be by your peers and experience with supervisors.

References: Barker, J. (2018). The Power of Communication â&#x20AC;&#x201C; It may Heal or Harm. Retrieved 18 August 2018 from https://tomedicinewithlove.com/articles/thepower-of-communication-it-may-heal-or-harm/. Ha, J. F. & Longnecker, N. (2010). Doctor-Patient Communication: A review. The Ochsner Journal, 10(1):38-43. Seeman, M.V. & Becker, R.E. (2017). Osler and the Way We Were Taught. Medical Science Educator, 27(3):555-557. Vogel, D., Meyer, M., & Harendza, S. (2018). Verbal and non-verbal communication skills including empathy during history taking of undergraduate medical students. BMC Medical Education, 18(1):157. Warnecke, E. (2014). The Art of Communication. Australian Family Physician, 43(3):156-158.

Enactment David Athan Griffith University II

When the blue and red flashing lights lit up the emergency bay, the scream announced her arrival. Like a well-oiled engine, the doctors in dark blue scrubs came, emerged from their rehearsed positions followed by a tide of interns gliding towards the entrance through the hallways. The last haven before the afterlife. They paused around her broken form like, Aztec priests at a sacrificial altar. The woman lay on the stretcher, a pool welled from a ragged hole in her chest, into the cracks of the concrete ground creating a neon lattice of perfect red lines. Clear tubes swung into place, the plastic mask grasped her face, stretched over her pale white skin, forcing in air, pumping, pumping. The ritual went on. A doctor called for adrenaline, the vial went into the IV line and they all bent in close, pulling out silver instruments and thread attached to tiny metal hooks as they went to work suturing as if the fissure was like a rip in a pair of old jeans. Then the bell from the next world sounded and as movement ceased in that glistening fist of muscle, the throng paused and retracted their gleaming appendages, while the registrar took in that simple flat line. He called clear and applied the paddles, once, twice, thrice, her figure twitched and danced. An unseen puppeteerâ&#x20AC;&#x2122;s closing act. Then it was still.

Finding Your Voice in Open Disclosure Sarah Keenan University of New South Wales V

During my third week of paediatrics, I was involved in a medical error. A small and relatively harmless one; but an error nonetheless. The mistake involved bloods being drawn from the wrong patient which happened to be a needle-phobic 12 year old patient. Even though the bloods were drawn from an in-situ venous cannula, the patient’s distress was tangible. It wasn’t until the final sign-off when I crossreferenced the path form and tube stickers that I realised the mistake. From resident to student, it had been a simple slip in communication. But also slip from me too – I hadn’t double checked the form before drawing the bloods. So the first major lesson for me was one of self-accountability. Don’t let the safety net of supervisors stop you from doing things thoroughly yourself. Check things for yourself, every time. The second major lesson, and the one that deserves more reflection is that around the topic of open disclosure. Was this a mistake worth disclosing? How does open disclosure actually play out? And how are things different in paediatrics? First, open disclosure refers to open, honest, timely and empathic communication of medical error, including the significance of its consequences to patients and/or their support person(s).

Open disclosure is mandatory in Australian healthcare systems; it is considered a patient’s right, a core professional requirement of ethical practice, and an attribute of high-quality healthcare services. Research has found that most patients want to be made aware of all events and potential mistakes, as this cultivates an open atmosphere of dialogues crucial to patientempowered medical care1, 2. And yet, when it comes to practice only 15-50% may engage in open disclosure of error3. Fear of malpractice lawsuits, of losing patients’ trust and of emotional reactions of patients and their relatives, is a very real barrier to truth-telling. In the setting of minimal-harm errors or near-misses, the impact on the patient-doctor relationship is the primary concern. In these settings, the value of open disclosure might seem questionable. Certainly, in this scenario, I felt that it was worth withholding this benign mistake over rocking one of the greatest cornerstones of paediatric practice - parental trust. What I didn’t realise at the time, was that any mistake or near-miss represents the potential for another more serious incident, and thus should be properly acknowledged, both to yourself and the patient and family. What I also didn’t consider, was that transparency around error in paediatrics offers opportunities, although challenging ones, to strengthen the therapeutic relationship. 11

And so why not build trust in the setting of benign mistakes, for both practice, and for preparation for when serious mistakes occur or consequences emerge later down the track? Once the inertia towards open disclosure is overcome, the next difficult step is finding the appropriate words and time to do it. At least with timing, a clear consensus exists; the more immediate, the better. This mitigates further erosion of trust with perceived delay in truth-telling. What words? These should be tailored to the child and family, but most importantly the words â&#x20AC;&#x153;I am sorryâ&#x20AC;? should be said. Contrary to belief, these words do not equate to legal liability for an incident, as outlined by Section 69 of NSW Civil Liability Act 2002.

References 1. Fein, S. P., Hilborne, L. H., Spiritus, E. M., Seymann, G. B., Keenan, C. R., Shojania, K. G., ... & Wenger, N. S. (2007). The many faces of error disclosure: a common set of elements and a definition. Journal of general internal medicine, 22(6), 755-761. 2. Cleopas, A., Villaveces, A., Charvet, A., Bovier, P. A., Kolly, V., & Perneger, T. V. (2006). Patient assessments of a hypothetical medical error: effects of health outcome, disclosure, and staff responsiveness. BMJ Quality & Safety, 15(2), 136141. 3. Ghalandarpoorattar, S. M., Kaviani, A., & Asghari, F. (2012). Medical error disclosure: the gap between attitude and practice. Postgraduate medical journal, postgradmedj-2011.

Research shows that most parents do want to know. Accepting this and participating in open disclosure with my resident was an important step in cementing my professional integrity and self-awareness of my limitations.

Crossing Borders Speech at GHC Adele Evans - AMSA Crossing Boarders Coordinator Notre Dame University Sydney III

Hi everyone, my name is Adele Evans, I am the project coordinator for AMSA Crossing Borders. If you are not familiar with us we are your national refugee and asylum seeker health group. We aim to engage, educate and promote advocacy by medical students for the health and human rights of refugees, asylum seekers and undocumented migrants. We are so proud to bring this Open Medical student letter with the GHC team. It is a very simple but incredibly powerful way for you to get involved and reject as future doctors the inhumane, the illegal, and the incredibly harmful indefinite offshore detention of asylum seekers. Indefinite detention is illegal. Offshore detention is illegal. We all know this. What’s even more concerning are the conditions of these centres. they have been described the UN as “unsustainable, inhumane and contrary to its human rights obligations”. These inhumane conditions saw a 26-yearold dentistry student take his own life after five year on Nauru. He was survived by his mother and 14-year-old brother. It is in these inhumane conditions that women are too scared to shower in case of being attacked by guards, where resources

are so low they use tents as sanitary pads. Children as young as six are attempting to take their lives. There’s till remains 138 on Nauru. It’s all horrendous. It often feels like we are completely powerless in this situation. But that is not true. With this letter, we have an opportunity to demonstrate once again to the Government and to our community what the future doctors of Australia stand for. We stand for human rights. WE stand for the right to health. And we will not be silent Now I can’t promise you that this letter will change legislation, or it will create immediate change. But that cannot deter us. We are the future of healthcare, and advocacy for that future start today. And it doesn’t end with this letter. How? This is where we come in. At the end of GHC AMSA Crossing Borders is launching our National Refugee and Asylum Seeker Awareness Month. A month for you to be involved in change. It starts with the letter. After GHC Crossing Borders is going to take this letter national. 13

We need your help to get as many medical student to sign this letter as possible. Second, we will arm with your knowledge. We have created 4 education modules with information that we think medical students need to know. We have gathered this information for you because we are not getting if from the government, we are not getting it from the media and currently we are not getting it from our medical schools. So join us. Get onto the Crossing Border Facebook page and join our month. Sign the letter. Engage in our modules.

Let us start the conversation the government is trying to silence. And let our voices be loud Because we are the future of healthcare in Australia. And health is not a political matter. Health is a human right. I want to end on something Albert Einstein once said. â&#x20AC;&#x153;The world will not be destroyed by those who do evil, but by those who watch them and do nothingâ&#x20AC;?. To do nothing in the face of injustice is to passively support it. Let us take the power back into our hands, and create the world we want to be a part of It starts with us.

Educate and empower yourself.

Medicl students at GHC protesting against mandatory detention of asylum seekers

Jess Yang In Conversation with Gender Equity Jessie Zhang - AMSA Gender Equity Jess Yang - AMSA President-elect Gender Equity’s Jessie Zhang spoke with incoming AMSA President Jess Yang about her new appointment, being a woman in leadership, and why why it’s so difficult to find female treasurers. Congratulations on your successful AMSA Executive Bid! What led to your decision to undertake the bid in the first place?  Thanks Jessie! I think the tangible moment when the idea first clicked in my head was during Convention in Townsville that year, watching Elise Buisson (2016 AMSA President) give a speech at the Opening Ceremony and seeing how many medical students were engaged with not only what she had to say, but with what AMSA had to offer. I’ve had the absolute privilege of working with countless amazing volunteers in my medsoc and AMSA over the last four years and I really wanted to be able to take what they taught me back into the organisation. Tell us about your bid’s story – how did you decide who should be on your team, and how did you go about convincing them to embark on this journey with you?  It was actually in Townsville where I met my VPi, Jasper, for the first time. Over the next two years, we both branched out of our comfort zones and found the niches we wanted out of our roles. By the second half of 2017, we decided that we did want to follow that faraway thought to the end. Borrowing off Alex’s advice, it was important to us that our team had enthusiasm. I knew Todd, our

treasurer...but actually had no idea about his vast financial experience until after he had agreed to be on our team! Clare was our final addition to the team and really brought the whole dynamic together. She had very clear goals in terms of what she wanted out of AMSA’s advocacy and had a lot of driving faith behind the team. What advice would you have for other women interested in applying for highly competitive positions? There are so many positive female role models in AMSA that have a wealth of knowledge and experience. We’re lucky in our organisation to have a number of amazing female leaders and hopefully this continues to encourage potential applicants to seek out a role they’re working towards. The mentoring program was a great initiative that will help build connections between women looking towards leadership. Particularly, I was able to see six of the twelve Core 4 team from 2016-2018 as accomplished women in AMSA. Did gender have an impact whilst applying for AMSA president or previous leadership roles? This was definitely something that I did discuss with Alex and past Presidents during my bid process, and with my team. I’ve been lucky throughout my medschool journey that it has not impacted me very negatively thus far WSMS has had many recent female Presidents and great representation on their Executive. While I believe that I am stepping into a very supportive environment within AMSA, our team has considered the reality that this may not 15

be the case when dealing with other external organisations. What are your thoughts on the fact that 0% of the past 8 AMSA treasurers have been women? Treasury is an incredibly difficult role to fill Todd was a miracle when I overheard that he had financial and event planning experience I was excited! Over my time in AMSA, Treasury roles have historically been very difficult to fill and is reflected in the fact that non-medical students can hold the position. This may be a sign that there is not much overlap with medical students and previous financial experience. However, there may be a bias in seeing finance as a traditionally male strength and so, when we reach out to people to step up to the role, we could be subconsciously excluding women with similar experience. There is definitely a ground-up approach that should be looked at although the furthest back we can tackle within medical school is probably to shoulder tap women who have had budget/events/sponsorship experience within medsoc to upskill into a treasury position. What is the biggest obstacle you face when applying for leadership roles and how did you overcome this?  I definitely struggled with the feeling of being underqualified for a role I was looking towards, particularly when I applied for AMSA Rep towards the end of my tenure as Publications & Design Officer. While I very much enjoy graphic design and photography, I felt I had backed myself into a corner where I would only be able to take Publicationsrelated roles as I had for the previous two years. It took a lot of pep talks from friends to step out of my comfort zone into the AMSA Rep role as I feel I didn’t have that advocacy-facing experience. What ultimately got me over that feeling of inadequacy was understanding that you do not have to have a laundry list of all skills required for a volunteer role. There is always room to upskill and

learn - in fact, if you think you will not learn anything new from a position, pick another one! A volunteer role should be giving back to you as much as you are giving to it. How have you developed/strengthened your leadership skills? Following on from the previous answer, it’s really about proactively looking for opportunities to learn new things. There really is a point of diminishing return that you hit if you stick yourself in the same sort of role over and over again (sorry Publications!). Personally, I found that finding initiatives that threw me into the deep end to tackle weaknesses (e.g. improving time management by involving myself in a timesensitive project) gave me the motivation to target areas that needed to be strengthened. If you could tell your first year med studentself one thing about leadership, what would it be? You don’t have to be switched on at 100% all the time. I struggled for a while to juggle things I had agreed to and found myself very close to burn-out at the end of a year. I like to think of myself as a generally outgoing person, but that quickly spiralled into me being too agreeable and saying yes to literally any opportunity thrown my way, even if I couldn’t fit it into my schedule. Respectfully learning to say no and take care of yourself are definitely skills that first-year me would have benefited from.

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Soon We’ll All be Dead Ravi Naran University of Newcastle V Reproduced from UoN magazine Ductus I have a friend who I’ve known for quit a long time. Great guy, easily in my top 3 future groomsmen list. First guy I meet on my first day at a new high school in a new town. Both outsiders looking in who quickly became insiders looking out in a way. Both since bonded by an appreciation for the little things in life, waxing philosophy, increased patriotism for the country we love, and what we like to call the “ethnic burden of responsibility”. I often turn to this friend when something important in life warrants discussing. And the man is never short of wisdom beyond his years. But the last time I spoke to him, he summed up the situation perfectly with a simple line: “Soon we’ll be dead.” Sounds a bit morbid at first. It’s actually a very life-affirming statement. Sounds a bit like a rip-off of “carpe diem” or “#YOLO” at second. I like to think it’s a lot more nuanced than that (I know he certainly would). Let me explain. On the one hand, and probably the one that resonates with most people, is this idea of embracing life. Do what makes you happy, do things that you’ll enjoy, do things for the experience. And don’t make excuses or put it off. Do it today because, as Ne-Yo says, “for all we know, we might not get tomorrow”. Life is too short to not be enjoying it. Wanna take a gap year or travel? Do it! Looking to go for it with guy or girl you’ve had your eye on? Ante up! Got the opportunity to go get lit with your friends? Let me pour you your first drink! Because SOON WE’LL BE DEAD! Ah, whoa! But wait a sec! “Soon we’ll be dead” is a double-edged sword. Because while it might be life affirming, it is not an abdication of responsibility, to both others and yourself.

So you wanna take a gap year or travel? But you’ve got your dream job lined up and if you pass on it now will you get another shot down the line? Because soon we’ll be dead. So you’re looking to hook up? But is it time you start thinking about settling down with the right person and starting a family? Because soon we’ll be dead. So you’re ready for a big night on the piss? But is there more to be enjoyed in a weekend and life than getting wasted and suffering through epic hangovers? Because soon we’ll be dead. I can’t really answer these questions for you either way. It varies depending on who you are right now, what stage of life (or med school) you’re at, and what you’re looking ahead to (or if you even are looking ahead). Regardless, I almost guarantee your answer is different from 5 years ago, maybe even as little as 5 weeks ago depending on what’s been happening in your life. It’s all about knowing yourself, making decisions based on that, and then not apologising to anyone for it. So what was the point in sharing that as a President’s introduction for Ductus? 1/ I’m three days out from a 5th year long case and needed a 20min task to get me past my 3.30-itis 2/ Other presidents in the past have waxed philosophy in these intros, and this was the first thing that came to mind 3/ So that I can tell my friend I’ve done so and enjoy his response (which will undoubtedly contain at least three crying laughing face emjois) Take from it what you will. My 3.30-itis is cured. Back to it. Chur, Ravi Naran 18 UNMS President 2018

From the Convention Convenor Sid Narula University of Notre Dame Freemantle IV Convening Convention is like trying to assemble a puzzle, only it has 1000 pieces and no box with a picture on top to guide you. The Perth18 AMSA National Convention was held at the Perth Convention Exhibition Centre running from the 2nd to the 8th of July 2018. The event featured over 900 medical students from Australia and New Zealand and also a collaborative social night with the Australian Dental Students’ Association’s National Convention. The program featured 20 plenaries, 18 workshops, 21 breakouts, 5 excursions and keynote speakers such as Steven Bradbury, Yassmin Abdel-Magied, Professor Fiona Wood and Dr Nikki Stamp. The academic team designed a versatile program which was built around a plan for each day to feature activities which educated, inspired, entertained and challenged the mind of the delegate. The social team took us to new extraordinary heights with the Cirque Le Noir Gala Ball being the highlight of the week. The event doused the room in red, black and white and featured

fire performers, aerialists, snake charmers, fortune tellers and an array of roaming magicians to keep everyone entertained, and a truly extraordinary finish to the week and for me – my final convention. Rangers, I first came to AMSA in 2015 as a casual guest attendee of Council 2 on the weekend before M15 Convention with my good friend George Martin. Never in our minds would either of us have imagined that four years later we would have finished leading our own team of legends in such an incredible experience. Without badgering on, I’d strongly encourage you to explore your interests- talk to people who are doing roles or projects that interest you, and take up as many opportunities as you reasonably can – they all lead somewhere! For me, Convention has enabled me to build my communication skills, leadership skills, budget management skills and enhanced my creativity. If nothing else, it’s finally allowed me to have a legitimate answer to the all-time favourite interview question “What is your proudest achievement?”

From the GHC Convenors Alice Mizrahi and Gowri Shivasabesan Monash University V

Two years ago, when we heard that teams from Melbourne were invited to bid to host the 2018 AMSA Global Health Conference, we were excited at the prospect of being a part of the convening team. The only catch was, we both wanted to be the academic officers, not the convenors. Neither of us had much experience in running large events and we were not sure we would be able to accomplish such a monumental feat. If it weren’t for our amazing deputy convenor, Eliza, who found us and pushed us to lead a bid with her, we never would have considered applying. We then found Bec, our treasurer, to round out our all-female powerhouse executive. It is only because of the support from these wonderful women that we’ve been able to make our original vision for GHC18 a reality. We also managed to find the most motivated team of individuals in existence to commit 18 months of their lives to the cause. Without them, we would have had to hold our event outside in the rain and have easy mac for lunch every day. GHC’s success is all down to our amazing team and we cannot thank them enough for all of the time and energy they devoted to the job. GHC this year included an inspiring academic program with speakers from all disciplines and backgrounds. We heard about Australia’s human rights obligations from our power panel with A/Prof Gillian Triggs and Dr Fiona Lander, we enjoyed a candid conversation with Dr Susan Carland and Dr Maithri Goonetilleke as they talked about the way social violence affects health, and we learned about the complexities of negotiating nuclear treaties with Nobel laureate Prof Tillman

Ruff. We touched on how food can bring communities together, how we can be allies to our Indigenous community, how to help our LGBTIQ+ spectrum patients and we heard about the horrors of Manus Island from Behrouz Boochani himself. For the first time ever, we brought on-the-ground advocacy to GHC through our Projects stream, where students were able to start political advocacy, prepare a proposal for hospitals about becoming more sustainable, create re-usable feminine hygiene kits, learn how to cultivate compassion and more! We also launched our open letter, in collaboration with AMSA Crossing Borders, calling for an end to mandatory, indefinite offshore detention, which we encourage every medical student to sign, and have over 700 signatures so far. We had a huge social program that included UV face paint, fairy floss, a silent disco, roving acrobats, food drops, froyo, trivia, doughnut walls, photobooths and DJs direct from the Meredith festival line-up. In another GHC first, our half-day off-site program ran directly into the social night, creating our very own Splendour-esque global health festival. Our delegates enjoyed face painting, coffee tasting and live music while writing letters to refugees on Manus Island and Nauru, packing 200 birthing kits and learning how to divest from fossil fuels. We have been so inspired by how enthusiastic this delegation has been and the way everyone got around our advocacy efforts throughout the week. In addition to our collaboration with Crossing Borders, we also collaborated with AMSA Global Health’s other projects – Code Green, Healthy Communities and Sexual and Reproductive Health. We worked with them to 20

bring innovative workshops to delegates as part of our academic program and our global health festival. Our aim was to create an inclusive event the catered to everyone, and we’re really proud of our team’s efforts to improve the diversity of our speakers. Our speakers were 60% female or non-binary and one-third of our plenary speakers were people of colour, our delegation was 70% female and our 16-person Management Team included 13 women. This year we also introduced equity scholarships in an effort to make GHC more accessible to those who may otherwise not be able to afford to attend. We also offered scholarships to Indigenous students with help from AIDA to improve Indigenous representation at AMSA events. GHC was where we first found our global health family, so we hope we created that environment for all of you. We hope GHC will remain a place for every medical student to learn, grow, and meet their own global health family. Thank you all for being the most

wholesome delegation in AMSA history. We wish the absolute best of luck to the Sydney GHC 2019 team – we know you guys will do an amazing job. And finally, to anyone out there who has ever considered taking on a daunting role, whether that be a role on a committee at your university, an event convenor or even AMSA president; don’t ever count yourself out of the game. It’s always worth throwing your hat in the ring, especially for other women thinking of taking on leadership roles. It can be hard to believe you could be capable of fulfilling the role, but if you trust in your own abilities you might just find you’re better at it than you ever thought you could be. Find people to support you, have a strong vision and put your best foot forward. You never know what crazy two-year journeys you may end up on! With lots of global health love, Alice and Gowri

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