Contents: Letter from the Editor
Page 1
Letter from the Chair
Page 2
Meet the Frontier! Editorial Team
Page 4
30 Words of Wisdom
Page 6
Lived Experience Inspires JCU Graduate to Create Change
Page 9
Placement Support Tips
Page 12
A Torres Strait Islander Doctor’s Path to Healing
Page 14
Rural GP Bursary Reflection
Page 17
Rural GP Bursary Reflection
Page 18
AMSAxGPSN Rural Generalist Mentoring Program
Page 20
Rural Placement: A Whole New World
Page 21
Ten Lessons from a Year in Rural General Practice
Page 24
Rural Health Bingo
Page 26
Understanding the Privileges of Metropolitan Medicine: My Life-changing Experiences Working in the Remote Thursday Island Hospital.
Page 27
Rural Health; at the Coalface of Climate Change
Page 31
From Victoria to the Cape
Page 36
Photo by Eva Elijas from Pexels
Letter from the Editor Irene Roy, AMSA Rural Pubications Officer And we are back for round 2 folks, Frontier! Volume 6, Issue 2! Frontier! is AMSA’s official rural health magazine that connects medical students to the vast world of rural medicine. We are proud to call this one ‘Planting Seeds, Sowing Change’. ‘Planting Seeds’ encapsulates the beauty of a rural placement. Placements where students and doctors develop roots, grow bonds, and flourish in their rural towns. We see blooming connections to the local community, the staff, as well as growth within themselves as future well-rounded practitioners. It doesn’t get more personal than this. These experiences are simply the beginning; the seeds. We hope they ignite a spark and sow future change in these rural spaces for authors and readers alike. All that aside, we wouldn’t be here without a few helping hands. Amani, Bridget, Nipuni, Will, and Zoe, you guys are incredible. I’m constantly in awe of your thorough edits and the creativity you bring to the table. I wish you nothing but the best in your endeavours (especially rural health ones...) in the years to come! To the AMSA Rural Health Committee, thank you for supporting me through the highs and lows. I’ve been fortunate to work beside such passionate individuals this year. Thank you to all the contributors that shared their pieces. Your stories plant seeds of knowledge that inspire growth in our own ways. This edition encompasses all the things I love about rural health and I hope you enjoy the read as much as I did! And of course, thank YOU. Thank you for opening up this magazine. Thank you for helping shape the discourse around our rural health gaps. You hold some seeds for change and I hope you sow them in whatever field you enter. If you’d like some help, have any questions, or are keen to get more involved, hit us up at rural@ amsa.org.au. On that note, get those RMs on your feet, and Akubra on your head. Let’s go sow some seeds!
Sending love, Irene.
Letter from the Chair Jasmine Elliott, AMSA Rural Health Chair
Hi everyone!
It’s Jasmine here, your AMSA Rural Health Chair and 4th year from Monash. Welcome to the second issue of Frontier! for the year. I’ve been so excited to see what Irene and her amazing editorial team would create, and am thrilled for them to now share it with you. This edition covers the breadth of rural health — from embarking on your first rural placement, through to practicing as a rural generalist. Here, we hope you can find some practical advice and inspiration; or, if you’re in lockdown, a meaningful time-filler for your morning, afternoon or evening. It has been my absolute pleasure to help guide the committee in such a tumultuous year. I wish, sincerely, that we could have been able to share hot choccies on a Saturday morning at retreat, travel to Canberra for advocacy, and meet up for AMSA’s three councils, but I am also eternally grateful for what we have been able to accomplish. This year, our committee has participated in a wide array of activities and, in spite of COVID’s continued attempts to derail us, we’ve achieved so much. We planned (and cancelled) three committee retreats, convincing ourselves in the process that ‘rural health retreats’ must be an extra aetiological agent for COVID-19 outbreaks. Nevertheless, we caught up monthly over Zoom; ran our first ever mentoring program alongside GPSN (which connected over 50 students with rural GP mentors!); received ethics approval for our Australian Rural Clinical School Support Survey (stay tuned in 2022!); worked with project teams at the National Leadership Development Seminar; met with politicians, and wrote countless policy submissions and media releases.
Photo by Bevan Kay on unsplash.com
Page 2 // Letter from the Chair // Jasmine Elliott
We are also in the process of delivering a series of interviews with people at the intersections of rural health in ‘Stop Beating Around the Bush’. There is so much more that I could boast about, but there’s exciting articles to get to! In lieu of writing many soppy pages of gratitude, I would like to also thank our Rural Health Committee — Alastair, Ella, Anant, Irene, Maddy, Laura, Dana, Erica, Izza and Claire — for their undying passion for rural health, and making my year as Chair one to remember. After two fulfilling years on the committee advocating for the healthcare of rural Australians, I am returning to Bendigo for my final placement next year. Hanging up my ‘AMSA Rural Health Hat’ feels like the end of a cherished chapter in my medical career, but I look forward to watching the exciting work of the RHC from a distance. On a side note, it wouldn’t be a letter from the Chair if I wasn’t spruiking an opportunity to get involved! Callouts are currently open for our General Committee, and close on the 26th of September; check our social media pages (Facebook, Twitter or Instagram), or email rural@amsa.org.au for more information. Keep an eye out also for news about the next Rural Health Summit, co-convened by Mara and Stephanie! A particularly special thank you to Irene, and her editorial team, for bringing their creativity and skills to Frontier! this year. I remember opening a document after the editing process to see it littered with 150 comments — which is either reflective of my writing ability, or the team’s attention to detail. Personally, I think it’s the latter! Every article you’ll see has made it through multiple rounds of edits before making it to the final stunning electronic publication! If you haven’t read Issue I, do make sure to check it out. I hope this edition of Frontier! inspires you, and maybe even challenges you, and that you too have the privilege of working, training or living in a rural community at some point in your journey. Grab a cup of tea or coffee, snag a biscuit, and dig into this wonderful magazine.
Meet the Frontier! Editorial Team
Bridget Marshall
Throughout the six years of my UNSW medical degree, I have spent 50% of the time in Port Macquarie, at one of the five rural campuses my university has to offer. I have gained so much experience doing my clinical placements in a smaller hospital – a place where everyone knows each other, and every set of hands is needed. Having grown up in the country and now having studied in a rural area, I am passionate about sharing with others the wonderful life people can lead living and working in the country. I have always enjoyed art and writing as hobbies outside of medicine, and so I saw being a member of the Frontier
team as a way to engage in my hobbies whilst simultaneously promoting the rural lifestyle that I love. It has been wonderful working with the team to produce two excellent editions of Frontier!
Having constantly moved around Australia during my childhood, the decision for my family to have eventually settled in Wagga Wagga said it all: there’s nothing quite like country life! However, of course, the challenges of being rural become all the more evident when it comes to healthcare, as I saw the list of issues from our public health lectures have very real impacts upon my own family, friends and community – it impressed on me the importance and the privilege of becoming a doctor and an advocate in this tight knit community.
Nipuni Hapangama
Being an avid consumer of Frontier! myself, it was inspiring to read the stories from the people facing those very issues head on, while also portraying the overlooked raw beauty of rural medicine, especially from our own student community. The opportunity to join the editing team for Frontier!, to celebrate the mix of science and humanity in a rural context with this amazing team of authors and editors, was one I couldn’t possibly forgo. I hope you find something inspiring within these pages too, just as I have!
Photo by Martin Damboldt from Pexels
While I’ve lived most of my life in metropolitan areas, from the UK to Melbourne, I’ve always been interested in the different social dimensions that affect access to healthcare. I think, in order to be good clinicians, we should strive to both educate ourselves on the different barriers to healthcare that people experience, and to advocate for effective, equitable, and universal access to that healthcare.
Zoe Weimar
I applied to help edit and format Frontier! to learn more about both the access issues present in rural medicine, but also the more overlooked richness and variety of experiences in rural medicine. The privilege of helping with Frontier! has certainly opened my eyes to the opportunities rural medicine presents, and I hope reading these editions will do the same for others.
Amani Azlan
Born in Malaysia, I moved to Perth in 2018. As if Perth wasn’t far enough from home, I came up to Townsville to study at JCU. After accepting the fact that I might not get Krispy Kreme or good boba for a few months, I started opening my eyes to the beauty of living in a remote community. It was such a nice change from the hectic city, to be honest. You never know what you can discover here in North Queensland! Just remember that, ‘Life is what you make it to be.’ So I joined the awesome Frontier! Editorial Team to perhaps change your views on rural health.
Last year, I was based in Wagga for my third-year placement. Out there — especially in the year that was — I felt keenly the disconnect between the metropolitan-based faculty and our rural cohort.
Will Choy
More broadly, I also gained a sense of the all-toopervasive neglect that faces our country towns. Despite occasional outpourings, there’s little sustained sympathy for apple-growers in Bago post-fireseason; farmers in Coolamon during the drought, or Windsor rebuilding after the flood. I applied to edit Frontier! with the hope that, in a small way, I could contribute to that conversation. So, thank-you for taking the time to read our work, and this journal. I hope you found some benefit from doing so.
Page 5 // Meet the Frontier! Editorial team
Words of Wisdom by awesome medical students around Australia
Photo of statues with plastic by Anna Shvets on Pexels
Photo of paper cutouts by Nadezhda Moryak on Pexels
RURAL PLACEMENTS Be friendly to your colleagues in the country. They are smaller cohorts, so look out for each other — share experiences, take turns in procedures, and life will be much easier this year! Alastair Weng, MD4 Melbourne
Rural placement will offer you so many opportunities to be involved. Say yes to all of them! Ella Johnson, 5D Monash
Immerse yourself, whether it’s in the hospital or the community. Joining a community group or sports team really helps settle you into your home away from home, and understand your patients’ context. Jasmine Elliott, 4C Monash
It’s tough to break into rural communities, but when you do, it’s worth the toil. Play a sport, go to the pub, put yourself out there and get stuck in. You’ll either come back to the city the better for it, or fall in love with the country and stay there for good! Will Choy, Year 4 UNSW
Page 6 // 30 Words of Wisdom
Smile and give it everything you’ve got; you’ll get out as much as you put in. The more you engage in the hospital, and the community, the more you’ll learn and the better connected you’ll be. Maddy Green, 5D Monash
Don’t be afraid to ask questions on ward rounds, and speak to patients. Asking questions can be daunting at first, but it shows you have an interest in what’s going on. And patients also love to chat, and are enthusiastic about training the next generation of doctors.
It is completely normal to feel overwhelmed and out of your depth. We are great at only remembering the negatives — so each night write, or tell your fellow placement buddies one thing you knew, got right or felt good about. Go for walks to familiarise yourself with your community — it helps you feel more connected. Also, engage in conversation with patients about the community, they can teach you a lot!
Claire Demeo, MD4 Melbourne
Edwina Fry, MD3 Deakin
COMING FROM A RURAL BACKGROUND Being from the country, you carry some awesome experiences about rural life! Don’t hesitate to share these and help shape the discourse around rural health. You may go through some tough changes (like moving away from home), but these offer a unique opportunity to grow and better understand yourself as a future doctor. Irene Roy, 3B Monash
Rural roots are a wonderful asset in medicine — your background will help you connect with patients in ways that your metropolitan peers can only dream of. Embrace the experience and growth associated with your new ‘city’ lifestyle too; broadening your horizons will make you an incredibly well-rounded doctor. Laura Beaumont, MD3 Western Sydney
Coming from a rural background is an asset. University can teach you to pass exams, but lived experience will give you the ability to connect with patients. Ella Johnson, 5C Monash
I felt like a small fish in a very large pond — the campus had a larger population than my home town. Stick with it, and use your story as a strength rather than a weakness! Jasmine Elliott, 4C Monash
Coming from a rural background, I felt a huge amount of imposter syndrome when I started medicine. Remember that you deserve to be here, make the most of every opportunity, and use your experience to become an amazing future doctor. Claire Demeo, MD4 Melbourne
Each of us arrive from a different background and, therefore, have something unique to offer our peers. When we share our experiences, we help shape both ourselves and those around us into more wellrounded and aware clinicians. Edwina Fry, MD3 Deakin
You are not alone. Sometimes being rural, you might feel that way — but you’re not. Know that there are other students who are doing med from ‘woop woop’, and all of us have something unique to offer. Don’t doubt yourself, get involved, and enjoy the ride. Sarah Steve, 3B Monash
Photo by Engin Akyurt on Pexels Page 8 // 30 Words of Wisdom
LIVED EXPERIENCE I N P I R E S J C U G R A D U AT E T O C R E AT E C H A N G E By Dr Fai th C hi tongo Wri tten b y A ndrew Cramb, Jame s C o ok Univer si t y C ommunic at ions C o ordinator For Dr Faith Chitongo, growing up in the rural north-east of Zimbabwe exposed her to the deadly consequences of inadequate health care services. For her, medicine isn’t just a job — and goes beyond being a passion. Inspired to act, she completed a Bachelor of Medicine/Bachelor of Surgery at James Cook University (JCU). After graduating in 2020, Dr Chitongo is now right where she wants to be, putting her new skills to use in regional and rural hospitals.
Witnessing the impact of preventable illness: I grew up in the rural district of Wedza in Mashonaland East, Zimbabwe. Health care services were limited in this remote area, and deadly diseases were rife. From a young age, I witnessed the premature deaths of relatives and friends from otherwise manageable tropical diseases such as cholera and malaria, and medical conditions such as diabetes, cardiovascular disease and HIV/AIDS.
Pursuing a career that makes a difference: Education was emphasised in my family. My father strived to further his education here in Australia, allowing me the opportunity to come here at the age of 11. I knew I would go to university, but was, for a long time, uncertain of what I would do. In Year 11, I was inspired by a family friend who was a doctor in regional Victoria. He spoke of the limited access to healthcare in rural areas, and of the need for more doctors to redress the gap between country and city areas. His stories about patients were fascinating and stirred something in me. I aspire to be like him, and make a positive impact on rural and remote communities.
Page 9 // Lived Experiences // Dr Faith Chitongo
Dr Fa i t h Chitongo at JCU To wn s vi l l e
A university with a shared commitment to rural and remote health: I wanted to study at a university that shared my outlook on health. With a strong focus on rural and remote areas, JCU’s College of Medicine and Dentistry was the perfect choice. JCU, throughout my degree, has provided me with many opportunities to explore the various aspects of country medicine. I’ve been on clinical placements in Ayr, Townsville, Mount Isa, Boulia, Mackay and Atherton. These placements offered me a chance to explore different specialties, network with other health professionals, improve my self-confidence and grow my sense of responsibility. My most memorable clinical placement was my fourth-year rural placement in Mount Isa and Boulia. It was there that I saw, most pointedly, the social and emotional burdens that disease imposes upon rural folk.
Being equipped with the skills to hit the ground running: My final year of medical school was a period of great personal and professional growth. Not having to worry or stress about exams allowed me to focus wholly on my clinical involvement and development. I spent the first 20 weeks of my final year in the Atherton Tablelands, and the rest at the Mackay Base Hospital. In Atherton, I got the opportunity to improve my confidence in consulting patients, clinical reasoning and performing procedural skills. At Mackay Base Hospital, I completed rotations in emergency medicine, anaesthetics, respiratory medicine and mental health. I gained valuable skills — ones that I will use not only as an intern, but throughout my career. Overall, JCU has equipped me with all of the foundations I need to start my career as a doctor. I now aspire to further my knowledge and skills, and be the best doctor I can for my patients. Page 10 // Lived Experiences //Dr Faith Chitongo
Fa i t h a t t h e Ma c k ay B as e H o sp i t a l
A lifestyle of making memories: I was never bored outside the hospital. On my Atherton placement, I got to explore the beautiful Tablelands. On weekends, friends and I travelled between waterfalls, tea farms, and fresh food markets in nearby towns. It was so much fun! My friend and I even recorded ourselves dancing across some popular destinations in the Tablelands (https://www.youtube. com/watch?v=lWRI5XqxiF8).
Getting straight to work where I am needed: I am completing my internship with the Mater Private Hospital, Townsville. As a Mater intern, I get the opportunity to work in private, public (Townsville University Hospital) and rural (Mount Isa) hospitals. I am always looking for ways to develop my skills and experience new environments. I am grateful for this opportunity, and I’m looking forward to helping out the Townsville and Mount Isa communities.
Fa i t h m e e t i n g Ma l c o l m Turn b u l l
To those commencing their medical journey, though it poses its challenges and trials, with a good study-life balance, perseverance and resilience, it’s all worth it in the end! Permission has been received from the initial publisher for this republication
Photo by Lidia Riehman o n P exe l s
Placement Support Tips
WHAT DOES A GOOD PLACEMENT LOOK LIKE: • Access to mentors — either in the community or on placement; • More autonomy (within a reasonable scope) = more serotonin; • Not feeling rushed or pressured to learn at a break-neck speed; • Getting to head out on hikes or to community events on the weekends and in your spare-time; • Having time to take in the fresh air every day; • Really friendly staff at the small rural hospitals; • Financial support from uni/other organisations; • Support with: - Travel - Accommodation - Internet • Community Involvement/Integration; • Study/common areas for students; and • Adequate, appropriate and skilled supervision
THINGS THAT ALL STUDENTS SHOULD HAVE ACCESS TO (AS PER THE AMC1): • Staff necessary to deliver teaching, administration and support; • Sufficient supervision to develop skills before participating in care; • Equitable assessment methods compared to metropolitan counterparts; • Opportunity to provide feedback; • Ways to access support for disabilities, medical and mental illness, cultural needs; • Access to necessary technology (i.e. internet, computers, library resources); • Teaching from clinical staff who have time allocated for teaching;
Page 12 // Placement Support Tips
Photo by Thirdman from Pexels
1. Australian Medical Council. Standards for Assessment and Accreditation of Primary Medical Programs by the Australian Medical Council 2012 [Internet]. Kingston, ACT; 2012 [updated 2016; cited 2021 Aug 18]. Available from: https://www.amc.org.au/wp-content/uploads/2019/10/ Standards-for-Assessment-and-Accreditation-of-Primary-MedicalPrograms-by-the-Australian-Medical-Council-2012.pdf
Photo by Klaus Nielsen on Pexels
PREPARATION AND SELF-CARE STRATEGIES: • Consider and plan out issues such as transport, accommodation and supervision before you go; • If you don’t have a car and/or cannot drive, ask your university if you can be placed with a friend who can help; • Reach out to those who have been previously placed where you are headed; • Join in as many community activities that you can! Explore options for things that you usually do, and don’t be afraid to try new things; • Exercise! Walk, cycle, run or find HIIT buddies at the park. Rural sport clubs are fantastic; and • Explore the surrounding sights e.g. hikes, and satellite towns (which always have a tip-top chocolate factory, cheese shop, or bakery).
WHERE TO GO IF THINGS AREN’T OKAY: • Australian Medical Students Association (AMSA) Rural Health Committee (rural@ amsa.org.au); • Your Rural Health Club, representative or medical society; • University wellbeing officers or staff; • Rural Clinical School or site sub-dean/ dean/coordinator; • Fellow students; • Psychologists; • Community organisations like Headspace; • Seeing friends or family when you feel isolated — via Zoom, or by travelling home if possible; • Make friends with the senior nurses, or unit managers, and go there for help with issues on the ward; and • Ask the local health team you are with for assistance.
RED FLAGS: 1. Not feeling safe on the wards; 2. Not feeling like patients are safe on the wards; 3. Feeling overwhelmed, excessively tired, or burnt out; 4. Feeling isolated; 5. Struggling to find accommodation and/or being unable to afford accommodation; 6. Staff always being too busy, or seeming perpetually unmotivated, to teach; 7. No appointed contact for wellbeing-specific concerns; 8. Being sent home early/lack of effort in arranging learning opportunities; 9. No cultural orientation training about the local Indigenous community; 10. Feeling that there isn’t a supportive environment for junior doctors or nurses; 11. Lack of contact with other students/significant isolation; 12. Being unable to find the mental/ physical health support you need; 13. Bullying or harassment from hospital staff, administrators, or other students.
A Torres Strait Islander Doctor’s Path to Healing By Janine Lucas James Cook University Communications Coordinator
Dr Nathan Passi is an emergency medicine registrar at Townsville University Hospital.
JCU graduate Dr Nathan Passi wants to inspire a new generation of Aboriginal and Torres Strait Islander doctors, and be a changemaker in the field of Indigenous health. The Townsville University Hospital emergency medicine registrar is proud of his Torres Strait Islander heritage. For him, the theme of NAIDOC Week in 2021, ‘Heal Country’, holds a special significance. His family are direct descendants of Sam and David Passi, two of the five Murray (Mer) Islanders whose battle for land rights resulted in the landmark Mabo ruling.
“Country represents identity, spirituality and connection,” he says. “Country is very important to my family and people, and my ancestors fought for recognition of Indigenous land rights and identity as plaintiffs in the Mabo case. I would encourage people to read about Indigenous history, to learn about your local area, and to really connect with the country we are so fortunate to live on.”
Page 14 // A Torres Strait Islander Doctor’s Path to Healing // Janine Lucas
Taking time to connect
Dr Passi’s training in emergency medicine has included two rotations to Palm Island, the largest Indigenous community in Queensland. He says this experience has had a significant impact upon his career. “Emergency medicine is a fast-paced specialty. It’s all about quick assessments and decisions. No one wants to come to the Emergency Department, and for most people it is the worst part of their day. Sometimes, due to the nature of the ED environment, it can be more difficult to form strong connections with patients,” he says. “In Mount Isa, I worked with amazing FACEMs (Fellows of the Australasian College for Emergency Medicine) like Dr Julia DeBoos and Dr Zafar Smith. They showed me the power of taking the time to connect with patients, particularly those of Aboriginal and Torres Strait Islander descent. But it was my time on Palm Island where I was really able to put this lesson into action.” “It was really eye opening to see how positively the community and Indigenous staff received me, and how well they responded to having an Indigenous doctor. It all stemmed from the time I took with patients and their families. My time there has made the biggest impact upon my career so far.” “As an Indigenous doctor, I am in a unique position to have a powerful influence upon my patients. Through my interactions, I’m hopeful that I can help break down barriers — to improve access to health services, encourage positive lifestyle changes,
and hopefully show young Aboriginal and Torres Strait Islander kids that they, too, can become doctors.”
Dr Nathan Passi holding a baby he delivered.
Bianca, Eva and Nathan Passi
Conversations about change
Dr Passi has recently assisted Dr Jon Hodge in establishing a pathway for Indigenous junior doctors at the Townsville University Hospital. He is also the cochair of the ‘Transforming EDs Towards Cultural Safety Committee’ at Townsville University Hospital, and is a trainee representative on the Australasian College of Emergency Medicine Indigenous Health Committee. He says he has become more active in Aboriginal and Torres Strait Islander health as a result of his clinical experiences in Mount Isa and on Palm Island. Writing in the Emergency Medicine Australasia journal in 2018, Dr Passi said it was important for Australians to acknowledge the differences between Aboriginal and Torres Strait Islander Peoples. He also emphasised the importance of understanding the continued influence and effects of colonisation, dispossession and the Stolen Generation.
“We forget that there were close to 500 Indigenous nations across Australia at the time of colonisation, each with a distinct culture and different belief systems. I try hard to have a conversation about that with my Indigenous patients — to better understand who they are and acknowledge where they come from. Our Indigenous patients want to be seen and acknowledged, and want their cultures to be celebrated.” Born in Mount Isa and raised in Cloncurry and Townsville, Dr Passi was a member of the JCU Medicine Class of 2014. He completed his internship and early residency in Mackay, with multiple rotations to Proserpine Hospital. From there, he moved to Mount Isa as a general practice registrar, and then transitioned into specialist emergency medicine training. He returned to Townsville in 2018 to continue his training in emergency medicine. He was joined by his wife, Bianca, who is also an ED registrar. The couple have a three-year-old daughter, Eva. “I continue to be inspired by my motivated colleagues who strive towards closing the gap in health outcomes for Indigenous Australians,” Dr Passi says.
Photos of palm Island taken by Dr Nathan
A pony on Mount Bentley, Palm Island
Permission has been received from the initial publisher for this republication
Rural GP Bursary Reflection Antonia Zeng, Monash University (IV)
Hello all, I am currently on GP placement in a town called Gisborne, about an hour away from Melbourne in North-West Victoria. I have been here for nearly a month and a half, and am really enjoying it. I’m getting to see a lot of things unique to the country, experiencing a level of independence that medical students rarely receive, and am enjoying being part of the local community. Here, I really feel like I have a healthy work-life balance. I have found that, in regional towns, you do tend to see more varied diagnoses than you would in the city. In the country, a person’s GP is often their first point of call for anything medical. This even includes acute, emergency presentations such as anaphylaxis and appendicitis. It has been super interesting to see these presentations outside of a hospital setting, and also to see how the whole community rallies to help those suffering.
Antonia on placement in Gisborne minimal commute (maybe 5 minutes from my house to the clinic) is amazing. I can finally get enough sleep, AND still have my own time to rest and recuperate between days of placement.
I am also enjoying the independence I have while parallel consulting. I am the first point All in all, I am loving my rural term — and of contact for patients, and I’m given the would recommend it to all students thinking responsibility of doing a preliminary workup about giving it a crack! and diagnosis before they see the supervising doctor. I’ve also been able to practise my reporting skills quite a bit — a skill that will be crucial as my career progresses. Furthermore, working in a regional community and gaining an understanding of the country way of life has been a privilege. Prior to this year, I’d never been able to see and immerse myself in a landscape outside of metropolitan Melbourne. Furthermore, being able to interact with the same team of doctors, who you can get to know, and the same clinical staff, who come to know you — it makes placement a very enjoyable experience. Lastly, the lifestyle here is great! Having the ability to go home and eat lunch in the middle of the day is a great break. Also, having a
Photo by Shelagh Murphy from Pexels
This rural GP elective was made possible through the RACGP Rural and AMSA Rural 2021 Rural Elective Bursary. Bursaries were available for Australian medical students in the final years of their degree to subsidise undertaking an elective GP placement in a rural area. Bursary applications are now open! Application Guide: https://docs.google.com/ document/d/1zxK4JDBzeylFJ1xhGVxXc_GeKdS7D47cgSZPn42xUpg/edit?usp=sharing Application Form: https://amsaorgau.wufoo. com/forms/wfdr03m0jdmvsm/
Page 17 // Rural GP Bursary Reflection // Antonia Zeng
Background photo by Maria Orlova on Pexels
A collection of film photos of Traralgon shot on Ilford XP2
RURAL GP BURSARY REFLECTION Lauren Wright Hill, Monash University (IV) As a student, rural general practice is all about the stories I’m told before my supervisor enters the room. I’ve settled into a routine: eight patients a day, two days a week. Each follows a familiar pattern. I usher people into the consulting room with a polite, “Please come on through and have a seat.” I ask them, “What can I do for (them) today?” I take their history, do an exam, and send a message to my supervisor. Then, we wait.
Lauren at her desk in Breed St Clinic
One patient, employed at the local paper mill, told me he works in a room that’s three times the size of the local Woolies. Despite this, and the fact that the mill is operational 24/7, the entire operation produces only one skip of rubbish per week. Their production processes emphasise waste reduction. The rolls which the sheets of paper come on are returned, and re-used. The wrappers around the paper stacks are designed to have minimal excess. The paper itself? Made entirely from recycled materials, with all off-cuts recycled in later batches. It was interesting to see how rural industries are adapting, and becoming more environmentally conscious. In other patients, I find a real sense of rural community.
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One patient who works at the power plant kindly told me of a local spot to have a picnic. Through the gates of the factory, there’s a great view out over the deep-cut mines, and even an audio tour available! From other patients still, I am privileged to hear impacting, human stories. One man who migrated from Holland after the Second World War told me about the Traralgon Dutch community, which formed in the wake of that conflict. He told me about being a little boy in the war, and not understanding the atrocities he witnessed until later in life. He spoke about how he still thinks about his Jewish neighbours from Holland, even as other memories dim with dementia. I’m often asked how far through my training I am, and whether or not I’ll return to Traralgon. People, it seems, genuinely want to know — it really is true that rural communities are willing
This rural GP elective was made possible through the RACGP Rural and AMSA Rural 2021 Rural Elective Bursary. Bursaries were available for Australian medical students in the final years of their degree to subsidise undertaking an elective GP placement in a rural area.
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and grateful to have students. I’ve only had one patient, in seven weeks, ask to see the doctor without me. I’ve even had patients go out of their way to compliment me — which I think has very little to do with my skill, and more to do with their kindness. I walked into House of Frank (a local bar/ Traralgon institution) for some pub trivia recently. As soon as I did, I was greeted with a boisterous finger levelled in my direction. “Oh! You’re my doctor!”, the trivia master exclaimed. The MC had recognised me from the day before: maybe I’d made an impact, but maybe it was the blue hair.
In previous city placements, I’d felt invisible. In Traralgon, I feel part of the team, and part of the community. I eagerly look forward to my remaining twelve weeks of placement here.
Bursary applications are now open! Application Guide: https://docs.google. com/document/d/1zxK4JDBzeylFJ1xhGVxXc_ GeKdS7D47cgSZPn42xUpg/edit?usp=sharing Application Form: https://amsaorgau.wufoo. com/forms/wfdr03m0jdmvsm/
AMSA x GPSN Rural Generalist Mentoring Program Claire Demeo, University of Melbourne (IV) This year, the AMSA Rural Health Committee and General Practice Students’ Network (GPSN) were very excited to collaborate on the provision of a Rural Generalist Mentoring Program. This nationwide initiative was inspired by passionate medical students, who want to tackle healthcare inequities and make a difference to communities all around Australia — regardless of geographical location. The program successfully recruited 51 mentees and 27 mentors from states and territories across Australia. Students have valued discussions with their mentors about the challenges and joys of their work, whilst rural generalists have benefited from sharing their knowledge and developing meaningful partnerships with future rural allies. As part of the mentoring program, AMSA and GPSN have also run two webinars, for both mentees and mentors, on topics relating to rural and remote medicine. We heard first from Dr Allison Hempenstall, a rural generalist working on Thursday Island. As an ACCRM (Australian College of Rural and Remote Medicine) Fellow, she shared some incredible stories with us, and imparted some of the lessons she has learnt during her time in the Torres Strait. In a subsequent webinar, we also covered First Nations allyship, and learnt about the importance of demonstrating cultural safety and humility in our work. We are so grateful for all the mentees and mentors who have made this program possible. We’re already looking forward to expanding the program next year, as we aim to inspire the next generation of rural generalists.
Page 20 // Rural Generalist Mentoring Program // Claire Demeo
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Sunset @ Green Fort Hill
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Bottom photo @ Friday Island
RURAL PLACEMENT : A WHOLE NEW WORLD By Akruthi Balaji Written by Andrew Cramb, James Cook University Communications Coordinator
Hands-on training, unique tropical medicine, and memories that will last a lifetime. This is what a James Cook University (JCU) Medicine rural placement in Far North Queensland is all about. Thursday Island is as far removed as you can get from second-year medicine student Akruthi Balaji’s hometown of Yellowknife, in the Northwest Territories of Canada. On her month-long remote placement, however, she immersed herself in the experience and has grown in her clinical skills and understanding of rural health care needs. Below, Akruthi shares more about her placement experience, and some of the many highlights.
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What was some of the practical work you did on placement?
I spent time in hospital, in a GP practice, and in a community clinic setting — so I got to see and do a lot! I took patient histories, assisted with physical examinations, and learned cannulation and venepuncture. I also observed and assisted in plastering, wound debriding, and anaesthetics in theatre. I got to see a variety of tropical medicine cases, which are quite unique.
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How would you d community
I loved how welcoming every as a student, to go into a co know anyone. It was lovely t the hospital, was welcoming take us places. This made f allowed us to get a better fee sorts of people, from clinical s and even some crayfish diver were happy to have a yarn, s genuine interest in
🤢 Did COVID-19 a
w
As a student, I m with small procedu affected by CO PPE we needed respiratory sym COVID-swab cert any investigation of counselling e vaccinated, and I requirem
What did you learn from the experience, and what have been some of your key reflections?
A big thing I learnt was how remoteness can significantly affect one’s access to healthcare. In class at JCU, we learn a lot about the challenges of living rurally and remotely — but it really hits home when you see it in person. From Thursday Island, the next hospital to refer to is in Cairns, which is a two-hour flight away. Because of this, the staff knew how to think on their feet, and be resourceful with what was available on the island. Similarly, it’s imbued in me the immense importance of knowing your local area, and being able to stretch limited resources far. It’s also really opened my eyes to how many options there are in medicine. I’m not set on a path yet, but I did become more inspired and passionate about wanting to do medicine throughout my time there.
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What did you g
I got to see a lot in and a on a boat trip to the inn saw the sunset from Gr Titui Cultural Centre. I went to Punsand Bay soccer with commun also lucky enough to g of the Light’ ceremony immer
describe the sense of y up there?
yone was. It’s quite daunting ommunity where you don’t that everyone, in and out of g to students and happy to for a great experience, and el for the community. I met all staff to construction workers, rs. Everywhere I went, people swap stories, and showed a n what I had to say.
affect the type of work you were doing?
mostly observed and helped ures, and was not significantly OVID-19. There was extra d to wear for patients with mptoms, and we needed to tain patients before starting n or treatment. I did see a lot encouraging patients to get also had certain vaccination ments as a student.
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Did you enjoy it, and would you recommend it to others?
Yes! I had an amazing experience, and would strongly recommend it to anyone. It was great from a clinical perspective, but also fantastic to immerse myself in the rural community. You get to see things from a very different point-of-view when you’re rural, which is quite cool.
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What’s your advice to a student preparing to go on placement?
Take the time to learn about the community you’re going to — especially about their culture and the social activities on offer. It really adds so much to the placement experience if you get yourself involved in both the hospital and the community.
get up to in your downtime?
around Thursday Island. We went ner islands, went to Friday Island, reen Fort Hill, and visited the Gab also visited the Kazu Pearl Farm, via helicopter, and played social nity members every week. I was go exactly in time for the ’Coming y, which is a unique and culturally rsive experience.
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Akruthi and a colleague at Thursday Island hospital
Page 23 // Rural Placement: A Whole New World // Akruthi Balaji
Ten Lessons From a Year in Rural General Practice
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General Practice is the centre of rural healthcare and every medical student should experience it;
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There is nothing more beautiful than being part of a woman’s antenatal care then meeting their baby;
Jasmine Davis University of Melbourne Rural Clinical School (VII) In 2020, I was lucky enough to undertake a year long placement in Rural General Practice as part of Melbourne University’s Extended Rural Cohort program. In this program, I was given the opportunity to shadow some incredibly talented Rural Generalists in Echuca who have worked in the field for 30+ years. Reflecting upon this experience, I’ve penned ten key lessons.
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A good GP can add many years to a patient’s life;
You can work in General Practice for 35 years and still see something you’ve never seen before;
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Being able to conduct a history, examination and formulate a treatment plan in 10 minutes is a true art;
It is possible to get 10,000 steps from one day of shadowing a Rural Generalist;
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Clinic nurses and midwives are incredibly skilled and so important in the success of a General Practice;
GP’s can often know that something is not quite right with their regular patient before the patient even opens their mouth; Being a medical student often means you are in charge of ensuring the child is entertained while a parent has their appointment - a great part of the job; and
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We need more committed, communityminded GP’s with a diverse set of skills in our country towns.
About the Author: Jasmine Davis is an MD/MPH student studying at the University of Melbourne in the Rural Clinical School. She has completed placements in Shepparton and Echuca as part of the Extended Rural Cohort. In 2021, she is studying a Masters of Public Health, completing subjects in health economics, policy, promotion and Indigenous health. Jasmine is also a previous volunteer for AMSA Rural Health and currently sits on the AMSA National Executive as the National Projects Officer. Page 25 // Lessons From Rural General Practice // Jasmine Davis
Page 26 // Rural Health Bingo
Understanding the Privileges of Metropolitan Medicine: My Life-changing Experiences Working in the Remote Thursday Island Hospital Sarah Perry James Cook University (VI) My final year of medical school has been one of contrast. I began the year with a clinical elective in my hometown at the Royal Hobart Hospital (RHH) Emergency Department. After that, I travelled to the top end of the country, undertaking a 10week rural placement on Thursday Island (TI), Queensland. When it comes to climate, geography, and even medicine, I doubt two placements could be more opposite in nature. My experience on TI has been among the most exciting and eye-opening I’ve experienced in university, and gave me valuable insight into the possibilities present in rural areas such as TI. To compare the two hospitals, the RHH is a well-resourced tertiary referral centre with 558 beds.1,2 Skilled consultants across the majority of subspecialties are available at the drop of a hat. In contrast, TI has a 26-bed general medical ward, a 6-bed maternity ward and a single operating theatre. There is no access to CT, or even an MRI.3 Despite this, TI Hospital and its primary healthcare centre manage to provide services to the islands which make up the Torres Strait region, the two mainland communities of Bamaga and Seisia (3), and prior to the COVID-19 pandemic, even some PNG nationals.4,5 During my 10-week placement on Thursday Island, I had the privilege of working in the ED, on the medical wards, in theatre, and out in the GP setting. I was lucky to have some incredible rural generalists as my supervisors. I was given the opportunity
to see my own patients, and present their cases to the senior medical officers — who valued the differential diagnoses, investigation and management plans I suggested. It was such a great learning experience, and I feel my skills dramatically improved in this short time. As the area’s primary care facility, I was also involved in helipad retrieval cases. We met patients on the helipad, and stabilised them in ED before either continuing their medical management on-site or referring them on to tertiary facilities such as Cairns Base Hospital. This often happened if TI Hospital did not have the appropriate resources, such as CT or specific specialists, to manage them appropriately. Some of my favourite experiences and learning moments happened in the ED. Because of the ongoing pandemic, the ED ran a separate ‘COVID-19 clinic’ for patients with respiratory symptoms. In consultation with supervising medical officers, I was often involved in managing the care of these patients. In the broader ED, I was also involved in managing acute myocardial infarctions, cellulitis cases, and acute fractures which required splinting, back slabs, and fibreglass casts. On two occasions, I also investigated cases of suspected tuberculosis (TB), and was intimately involved with the referral of patients to the TB specialists. My procedural skills also benefited, often getting to try my hand at the incision and drainage of loculated skin abscesses.
Page 27 // The Privileges of Metropolitan Medicine // Sarah Perry
On two occasions, the resident medical officer (RMO), who usually oversees the flow and management of the whole ED, was unable to work. This meant I was given the responsibility of ‘running the department’. I was the first port of call for all patients who walked through the door, independently working to take histories, and arrange and implement management plans. I would discuss my findings and proposed management plans with the rostered SMO, and they would either sign off on these plans, or suggest I undertake different courses of action. I came out of this much more confident in my own clinical ability. I had an equally positive experience working in the island’s GP service. Witnessing the management of chronic disease in the remote setting, among the largely Torres Strait Islander community, was a great learning experience. There were a few occasions where the clinic was understaffed, and I was given my own list of patients to see— again organising investigations and presenting management plans to the GP on-call for approval. I found this to be an excellent exercise in time management and prioritisation. I also had to work to meet the patient’s specific wants and needs; an important skill to nurture as a junior doctor. The GP centre would also host visiting specialist clinics, and I was fortunate enough to be involved in face-to-face ophthalmology and
orthopaedic clinics. These specialists either came from CBH, or videoconferenced into telehealth clinics. Witnessing this disconnect was a great reminder of the privilege I have experienced living and working in larger centres. It gave a meaningful insight into the barriers faced by remote patients, while also showing some of the ways these hindrances can be overcome. The TI Hospital also runs weekly endoscopy lists in the operating theatre. I was lucky enough to observe and assist in these procedures, learning some of the techniques used. The GP-anaesthetists on site were also extremely keen to teach. It wasn’t uncommon for me to roll up my sleeves, draw up medications, and assist with procedural sedations. Additionally, I was taught different methods to manage and maintain airways. This involved using simple techniques such as jaw thrusts, all the way through to inserting laryngeal mask airways (LMAs) and nasopharyngeal airways (NPAs) in more complex patients. This placed me in good stead for upcoming anaesthetics rotations. Attending the outer island outreach clinics was also a privilege. One such women’s health clinic took place on Poruma (Coconut Island), a 45-minute helicopter ride away from TI. We flew over several other islands on the journey, and I saw turtles, dugongs and sharks from the sky. It was such a surreal experience. It was eye-opening, however, to
Visiting Pearl farms and Chasing Waterfalls! Page 28 // The Privileges of Metropolitan Medicine // Sarah Perry
see the meagre resources available in these remote areas first-hand. It wasn’t all medicine, however. There was also an amazing social life for tourists on TI. The hospital staff often invited us to meals at the local pub, or to enjoy a sunset beverage at the Bowlo. We routinely went island hopping: visiting pearl farms on Friday Island, chasing waterfalls on Prince of Wales Island, and following in the footsteps of WWII soldiers on Horn Island. We also took trips by 4WD and boat to visit the northernmost tip of mainland Australia. I certainly made some incredible, lifelong friends on this trip, and I am so grateful for the experience I had with them. This experience on TI is something that I will never forget. I feel privileged to have been so involved and welcomed into this community. I learned a lot about the challenges of remote medicine, but also about the resourcefulness of the staff and community members who call these places home. It has made me appreciate the privilege I experience working in tertiary-level referral centres like the RHH, or even in Townsville, where I plan to start my career. My eyes have been opened to the fantastic possibilities of rural generalism, and I am excited to explore this avenue as a career option. Who knows, I might even practice back in TI one day!
Page 29 // The Privileges of Metropolitan Medicine // Sarah Perry
Sarah Perry 2021 1. Tasmanian Department of Health. RHH redevelopment: inpatient beds. Hobart TAS: Tasmanian Department of Health; 2019 [updated 2019 Oct 19; cited 2021 Aug 17]. http://www.rhhredevelopment.tas.gov.au/__data/assets/pdf_file/0006/405906/200203_THS_RHH_and_ Repatriation_inpatient_beds_1.pdf 2. Rockliff J. Hospital bed plan to increase capacity. Tasmania: Peter Gutwein, Premier of Tasmania Website;.2021 June 4 [updated 2021 Jun 4; cited 2021 Aug 17]. Available from: http://www.premier.tas.gov.au/site_resources_2015/additional_releases/hospital_bed_plan_to_ increase_capacity 3. Queensland Health. Thursday Island Hospital Profile [Internet]. Brisbane QLD: Queensland Health; 2021 [updated 2021 Jun 2; cited 2021 Aug 17]. Available from: https://www.health.qld.gov.au/services/torres-cape/torres_ti_hosp 4. Australian Bureau of Statistics. Changing characteristics of the Torres Strait Region and its people [Internet]. Canberra ACT: Australian Bureau of Statistics; 2018 [updated 2018 Sep 12; cited 2021 Aug 17]. Available from https://www.abs.gov.au/statistics/people/aboriginaland-torres-strait-islander-peoples/changing-characteristics-torres-strait-region-and-its-people/latest-release#data-download 5. Torres Strait Island Regional Council Website. Torres Strait Island Regional Council. Torres Strait Treaty and Border Movements [Internet]. Torres Strait Islands: Torres Strait Island Regional Council; 2020 [updated 2020; cited 2021 Aug 18]. Available from: http:// www.tsirc.qld.gov.au/community-entry-forms/treaty-png-border-movements
Page 31 // Rural Health: at the Coalface of Climate Change // Jasmine Elliott
Page 32 // Rural Health: at the Coalface of Climate Change // Jasmine Elliott
Page 33 // Rural Health: at the Coalface of Climate Change // Jasmine Elliott
Page 34 // Rural Health: at the Coalface of Climate Change // Jasmine Elliott
The jetty on Friday Island
From Victoria to the Cape By Meagan McKelvie James Cook University (VI) Meagan McKelvie, a sixth-year Medicine student from James Cook University, reflects on her recent eye-opening rural placement to Thursday Island and Cape York.
Ferrying across the jewel-blue skin of the Torres Strait, visiting its numerous islands, the tip of mainland Australia glimmering in the far distance. Gazing down at turtles and dugongs from the sky, breaching the surface of the ocean below. Driving through dense rainforest to Pajinka. These are just some of the highlights from my 10-week placement on Thursday Island and in the Bamaga/Northern Peninsula Area (NPA). Page 36 // From Victoria to the Cape // Meagan McKelvie
Arriving in January, amidst the thick of a humid wet season, was a shock to the system at first. Hailing from Gippsland, Victoria, it took me some time to get used to the frequent rain storms that hover over the coast. Nonetheless, the world up here is full of beauty and splendour. The rainforest of the Northern Cape envelops the communities of the NPA in an electric green, the earth below a rich, volcanic red. Metres-high termite mounds tower over the sides of the roads. Wild dogs and horses roam the township, slinking between the trees. In the Torres Strait, the islands are fringed with sprawling turquoise reefs, and the ocean sparkles under the glare of the equatorial sun.
The people of the Torres Strait and NPA live their lives with a resilience and sense of culture that makes them unforgettable. I was welcomed by their communities warmly and enthusiastically, meeting the elders and even learning a bit of the language. Here, people are dedicated to their families. Everyone knows everyone, and is related in some way through family, friendship, work or leisure. Both on Thursday Island, and in Bamaga, I would be stopped by the kind locals I had met on placement to have endearing yarns on the street. The medicine is unique, owing to both population characteristics and remoteness. There is plenty of work to be done in all kinds of settings. My placement included rotations through emergency, GP clinics,
hospital wards, and even outreach clinics to the outer islands of the Torres Strait and NPA (via helicopter!). Unfortunately, conditions like diabetes, obesity, heart disease, and their preventable complications are key health issues for the Torres Strait Islander and Aboriginal Australians here. Sadly, they suffer from some of the worst health outcomes in Queensland. In Bamaga, I came to know many patients well, and began to recognise the underlying issues affecting their health. Distrust, dislike of taking medication, and difficulties in quitting smoking or sugar were some barriers that we encountered. However, many patients were also proactive, mindful and receptive of the health advice.
Meagan in a helicopter on her way to the region’s outer islands
Like the landscape, the medicine, too, changes with the seasons. During the wet months, infection is ubiquitous. For weeks in my summer stay, the ward on Thursday Island was at capacity with skin infections. Diabetic wounds in adults, and skin sores and bug bites in children, were the most common presentations. Additionally, the usual antibiotic regimes are rendered useless here, with occurence rates of Methicillin-resistant Staphylococcus aureus (MRSA) well beyond 30%. For children, this means frequent, painful injections with a long-acting antibiotic — necessary to prevent acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Holding these children
down, while they cried in pain, was very difficult. Unfortunately, it is something that you quickly become accustomed to. Notwithstanding ongoing public health efforts, these areas have the highest prevalence of ARF and RHD in the world. During my time in Bamaga, I saw a case of ARF and its renal complications — and sadly, RHD was all too common in patients. Always, as well, hidden dangers lie beneath the calm sea. Toward the end of my placement in Bamaga, a teenager died from a fatal box jellyfish sting while fishing. It was the first jellyfish fatality in Australia in 15 years, with the last one also occurring in Bamaga. Page 37 // From Victoria to the Cape // Meagan McKelvie
Despite its highlights, this placement was difficult. This type of medicine is not for the faint of heart. With the endless rain, roads up the Cape flood and become impassable, and flights into the region are often cancelled. This renders the feeling of isolation and remoteness all the more acute. For much of the placement, I felt this isolation keenly. I found that meaningfully connecting with my colleagues and the local community was vital to surviving as an outsider.
To future students considering a placement here, I recommend it for the amazing medical experience and breathtaking landscapes.
However, to best enjoy Cape York and avoid cabin fever, a 4WD is a must. Without a good car or dry roads, there is little chance of getting around — and one certainly risks going a little stir-crazy. On Thursday Island, switch out the 4WD for a boat. In the future, I wish to pursue locum work to help fill gaps in the remote healthcare system. I also have an interest in general practice and rural generalism. I would love to work in a well-connected regional location, where I can hopefully strike a balance between city luxuries and the wild and wonderful outdoors. Find out more about how James Cook University is making rural health matter: jcu.edu.au/college-of-medicine-anddentistry/making-rural-health-matter
Meagan at the most Northern point of the Australian continent Permission has been received from the initial publisher for this republication
Page 38 // From Victoria to the Cape // Meagan McKelvie
