Hope4Health Annual Design

H4HANNUAL

2009

THIS MAGAZINE IS BROUGHT TO YOU BY HOPE4HEALTH

FEATURING PROFESSOR ROB MOODIE PROFESSOR JONATHAN CARAPETIS DR BILL GLASSON PROFESSOR SIMON BROADLEY

STUDENT ELECTIVES FROM SAMOA, NEPAL, SOUTH AFRICA + MORE

INDIGENOUS. LOCAL. RURAL. INTERNATIONAL. 1

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CONTENTS

CONTENTS 2

Welcome & Editor’s Note

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Profile Professor Rob Moodie.

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Article Dr Nick Thomson, ‘Patients or criminals, rhetoric and reality; substance use, incarceration and implications for the fundamental human right to health in South East Asia.

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Article Dr Geoff Spurling, Chagas Disease, Honduras.

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Article Dr Helen Longbottom, Homa Bay, Kenya.

10 Article Fijian Network for HIV + People (FJN+) and RED Party.

11 Article Nathan McCubbery, Kompaim District Hospital, Papua New Guinea.

12 Article Danielle Clark, Manguzi Hospital Kwazulu-Natal, South Africa.

13 Article David Shoesmith, Kamana Hospital, Tandi, Nepal.

14 Article Bridget Gilsenan, Samoa.

16 Profile Professor Simon Broadley.

18 Article HOPE4HEALTH Teddy Bear Hospital and HOPE4HEALTH Clinical Skills Sessions.

19 Profile Professor Jonathan Carapetis.

21 Article Walter Hipgrave ‘ A learning curve in Indigenous Health’

22 Article Michael Hurley, Gove District Hospital, Northern Territory.

23 Article Dr Bill Glasson.

25 Article Dr Michael Rice ‘Reflections on living and working in country medicine’

27 Article Jordan Whicker, Rural Experiences 2009.

28 HOPE4HEALTH About Us.

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PRESIDENTS REPORT

EDITOR’S NOTE Welcome to the first edition of the HOPE4HEALTH Annual. It is with great excitement that I present to our readers a representation of the opportunities that are available to you within the field of medicine and health. We have interviewed and received perspectives from people of different backgrounds and with different outlooks on medicine and life. Despite their differences, there is the same underlying desire to improve the lives of people who are in need. This desire can be seen in those who have risen to the top of their field, as well as in those who are just beginning.

I hope that there will be many more editions of the HOPE4HEALTH Annual.

And I also hope that as more graduates depart Griffith University that we continue to hear your stories.

Claire Cuscaden Editor of HOPE4HEALTH ANNUAL, 2009.

PRESIDENT’S REPORT 2009 The changing face of Australian medical education has seen a shift from the traditional didactic undergraduate style teaching to postgraduate contextual problem based learning.

From a student club position one of the greatest advantages of this shift is the vast diversity of backgrounds possessed by postgraduate students. The wealth of experience demonstrated by Griffith Students along with their well-developed social conscious has provided HOPE4HEALTH with an amazing resource of volunteer effort. What HOPE4HEALTH has managed to achieve this year is a tribute to all members and should be something that Griffith Medicine and Allied Health students are proud of.

To provide a brief history of the club, HOPE4HEALTH was initially formed around the 2006 fundraising efforts to build the Dabaa Medical Centre in Ghana. However after the success of that event the club redefined its role.

Based on the core ideal of targeting areas of health disadvantage or inequality the club now has four main target areas: Indigenous, Rural, International and Local health.

Many other Medical Schools around Australia have medical societies and international, rural, Indigenous and other special interest clubs.

HOPE4HEALTH is unique in being the only club that combines aspects of Indigenous, rural, international and local health. Consequently HOPE4HEALTH has set a benchmark for having the highest proportion of student members compared to other societies. From the club’s perspective, this is a very positive outcome as it allows streamlining of core administrative and promotional effort whilst still providing a broad range of opportunities to students.

On a personal level being involved with HOPE4HEALTH has allowed me to see and do things that I would never have thought possible as a student. I’ve travelled to conferences in Noosa, Launceston and Cairns, spent time in the Cherbourg Aboriginal Community, attended a rural health club weekend with 80 students from four Queensland universities and experienced some amazing social events that raised significant funds for a number of different charities. I have no doubt that these experiences

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will only help me in my future career and am incredibly grateful to all the HOPE4HEALTH members for their hard work that has created the chance to be a part of it all.

One of the most popular opportunities provided this year the Clinical Skills Sessions organised by our Vice President Alix Longbottom. These sessions rely on senior students volunteering their knowledge and experience to teach junior students aspects of history taking and clinical examination.

Given that medical education is rapidly evolving to more interactive and contextual based learning, these sessions have illustrated improvement in both the retention of knowledge and its application.

From the student teachers’ perspective it also allows the development of skills that will be highly valued throughout a medical career. As Professor Broadley states in his interview, “clinical education is largely an evidence free zone”. Excitingly, the HOPE4HEALTH Clinical Skills Sessions are set to provide a template for future study into senior student based medical education. It is hoped that this will help provide evidence to support a program that has the potential to be used by medical schools throughout Australia.

It has been an absolute pleasure to be a part of such a passionate organisation. The most impressive feature of the group is the fact that it is based exclusively on students choosing to give up their time whist living with the pressures of studying Medicine. This dedication and hard work is the essence of HOPE4HEALTH’s success and it is pleasing to see this success acknowledged externally through the receipt of a number of awards. On a university level the club has been awarded Cultural Club of the year two years running. On a national scale a presentation on HOPE4HEALTH’s fund and awareness raising activities was awarded the best student presentation at a recent national rural health conference. The overall success of HOPE4HEALTH has led to the club fast establishing an excellent reputation in the wider medical community, demonstrating the professionalism and high capability of Griffith Students.

With Walter Hipgrave as President in 2010, and a fantastic new council, the year ahead looks full of promise. Thank you so much to all HOPE4HEALTH members, it has been a privilege to work with you all!

Warwick Isaacson President of HOPE4HEALTH, 2009.

INTERNATIONAL

PROFILE PROFESSOR ROB MOODIE Biography: Professor Rob Moodie is the Chair of Global Health at the University of Melbourne. He has over 30 years experience planning and evaluating health programs in Australia, Africa, Asia and the Pacific.

He was the inaugural Director of Country Support for UNAIDS in Geneva from 1995-1998 and the CEO of VicHealth from 1998-2007. He is currently the Chair of the National Preventative Health Taskforce (an Australian Government initiative) and acting Chair of the Commission on AIDS in the Pacific. He also Chairs the Technical Advisory Panel for the Bill and Melinda Gates Foundation Avahan project for prevention of HIV in India.

He combines these with other roles including the Chair of the Melbourne Storm. He has co-edited and co-authored four books including “Promoting Mental Health”, “Hands on Health Promotion” and “Recipes for a Good Life” with Gabriel Gaté.

Could you describe the career path that took you to where you are today?

I got interested in developing world health as an undergraduate after doing an elective in Hong Kong and watching a documentary called ‘Five Minutes to Midnight’ in about 4th or 5th year.

After graduating, I did my internship in Albury as I was very keen to get out of Melbourne. I then went to the American Hospital in Paris as I was very keen to learn another language. From there I went to the Save the Children Fund in the Eastern Sudan where I spent a couple of years. Working in mother and child health clinics in the Sudan, I had to completely relearn Medicine.

I think this is where I became interested in Population or Public Health. I was so overwhelmed with the demands that I couldn’t help but think of how I could improve the situation as a whole. In the Sudan I got involved in health education for mothers with the aim of trying to understand the causes of ill health. I also became aware of a need to give as much control back to the refugee in that fragile environment. I also became interested in the design of refugee camps as well as the employment situation.

paediatricians more than any other group of doctor’s by virtue of their capacity to communicate with their patients. But I found the politics of the hospital quite disengaging for me. That year I had heard of this guy who had come down from Alice Springs and was talking about an Aboriginal controlled health service that was offering a 6-month rotation in Alice Springs doing Indigenous Health and a further 6 months doing O&G. So I did that for a year and I really loved it. I was asked to go back so I went to work in Alice Springs for Congress and that is where I really started to learn about the politics of health and understand the historical, cultural and social determinants of health.

You are the Chair of the National Preventative Health Taskforce that aims at reducing the burden of chronic disease by targeting the lifestyle risk factors – alcohol, tobacco and obesity. How do you manage dealing with powerful alcohol and tobacco corporations?

With tobacco industries the lines have been drawn for years and years. This doesn’t mean that their power is diminished. It just means that you have to get smarter and smarter fighting them. There are not many lower forms of life than the tobacco companies.

With regard to alcohol and food, food is essential but junk food isn’t. Alcohol is not essential but is widely used. This is where you need sensible regulation and legislation.

Leave it to a completely free market and the market fails us. Obesity is a commercial success but a market failure. Inactivity way outsells activity and junk foods are way out promoted and continue to out sell good food and good drinks. There are areas where we can actively work alongside alcohol and food and beverage companies, but there are areas where we will fight. We have to. Their job is to make as much money as they can, but in many cases this produces poor health. On the other hand with regard to alcohol, we can work together with the alcohol companies particularly with regard to binge drinking.

With most of the good alcohol companies, this does not help their image either. If you can sell a safer product and drink more low alcohol products, that can be good for business and good for health outcomes.

After this I thought I wanted to become a paediatrician and I came back to Melbourne and worked for a year at the Royal Children’s Hospital. As a student I had liked

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INTERNATIONAL

THE THING ABOUT PUBLIC HEALTH IS THAT IT GIVES YOU THE OPPORTUNITY TO WORK WITH HUNDREDS OR THOUSANDS AT ONCE. IT IS NOT ENTIRELY DIFFERENT TO WHAT YOU DO IN A CLINICAL SITUATION WHERE IT IS ONE TO ONE.

How do you plan to sell your ideas to the wider population?

The issues around alcohol have changed over the last few years where a much higher level of community discussion and concern around the secondary harms of alcohol has developed. There are similarities with passive smoking and ‘passive’ drinking. ‘Passive’ drinking is where people get assaulted, injured or killed by someone else’s drinking. It’s just like passive smoking. This has gotten more people interested with doing something about it. This has challenged the argument of the alcohol companies who have said that they really don’t need to do anything about population health as it just a minority that are problem drinkers. Now we are interested in the problems drinkers, as we understand that they impact on everyone else as well.

What do you love about your job?

The thing about Public Health is that it gives you the opportunity to work with hundreds or thousands at once.

It is not entirely different to what you do in a clinical situation where it is one to one. You need to use a lot of what you learn in these situations. When it is one on one, you spend all your time trying to diagnose, manage and treat. With Public Health it is the same but on a much broader scale. It is also far trickier and complex.

You have to think outwardly, and in Public Health we need as many good people to be thinking outwardly as we have highly specialised people who think inwardly.

My interest is in getting people to look back. It’s like the story about the guy who sits by the bank of a river?

He watches people come down and notices they are drowning. He jumps in and picks them up, puts them on the bank and resuscitates them. But it keeps happening and after a while of doing this he goes up the river to find out who in the hell is pushing them in. This is the same as prevention. You need the ambulance at the bottom.

But you also need the fence at the top of the cliff. It’s a fascinating part of medicine, of health and of our lives.

We need more and more creative people getting involved.

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What do you find most challenging?

If you take the National Preventative Health Taskforce, the most challenging aspect is managing competing views and developing a direction we all want to go in. It is political and highly charged. You have to manage the desires of bureaucracy in wanting to control everything.

You have a lot of competing players. As problems become more and more wicked, you need more and more people to solve them. It means you have a network that needs to be managed. It’s easy to just do everything by yourself, but in public health that just doesn’t work. Learning how to work with people and egos and institutional logos is a real challenge.

Even in medicine I remember in the early 70s that one of the attractions to the career was that you could work for yourself and that you could be your own boss. But now that is just not appropriate. You have to work in teams. There is just no economy of scale. It’s about teamwork and we need to learn the skills to be able to do this.

What sort of legacy do you want to leave?

I want my kids to be happy. That is my most important legacy. I want those that I work with and live with to have hopefully benefitted from knowing or working with me.

From a professional perspective my greatest interest is in the ethics and morality of prevention. For me it is a fundamentally moral thing to want to prevent human suffering. For an example and with great respect, the Catholic Church is interested in people only after they have HIV as opposed to before they get the disease. I am a utilitarian and I want to do the most good for the most people. That is not disrespecting keeping a balance between individual rights and collective rights, but there is an awful lot of preventing human suffering that we can do on a collective and a personal level. This is why I wrote the book ‘Recipes for a Greater Life’ which is about us as individuals, which is sort of the antithesis of my day job.

But you do see a lot of suffering and you want to know how you can prevent it.

INTERNATIONAL

ARTICLE DR NICHOLAS THOMSON PATIENTS OR CRIMINALS, RHETORIC AND REALITY; SUBSTANCE USE, INCARCERATION AND THE IMPLICATIONS FOR THE FUNDEMENTAL HUMAN RIGHT TO HEALTH IN SOUTH EAST ASIA.

Dr Thomson is a Field Director for Johns Hopkins School of Public Health, based in South East Asia.

In South East Asia, HIV epidemics have flourished amongst injecting drug users (IDUs) and their sexual networks and have resulted in some of the highest prevalence rates of HIV seen amongst any marginalized at risk population (MARP) groups. Prevalence rates of HIV have consistently been above 50% in IDUs in China, Vietnam, Burma and Thailand and only slightly lower in IDU populations in Cambodia. In addition, the availability and use of non injected methamphetamine has grown exponentially in the last decade across all countries in the Mekong. Illicit drug use is a complex issue and pits public security forces and their international obligations to counter trafficking operations against public health advocates and their role in the prevention and treatment of both drug use and HIV and other negative health outcomes associated with it. In the broader framework it pits the UN Narcotics Conventions against the Universal Human Right to Health. Without clear agreement that drug use is a health issue, thousands of drug users are likely to experience deleterious interactions with law enforcement communities, spend time in prisons or compulsory drug treatment centers and have their fundamental human rights violated. Perversely, the current prevailing and dominant security approaches to illicit drugs exacerbate negative health outcomes including HIV infections.

In South East Asia, recognition that drug use is a health issue has been slow to take effect despite many countries amending laws that recognize the need for a full and comprehensive health and human rights approach to drug use, many drug users are currently in prison or the prison like conditions of compulsory drug treatment camps. There is a need to respond to both injecting and non injecting drug use in South East Asia in a way that prevents the spread of HIV infection and provides voluntary treatment options for those who seek treatment for drug addiction. For those who are unable or unwilling to cease drug use, a comprehensive range of services collectively known as a harm reduction approach is necessary. Many countries in the world have adopted a harm reduction approach to injecting drug use which includes the free provision of sterile needles and syringes, the availability of opiate substitution medicines and uncompromised access to primary health care and other social services. In Australia, it is estimated that this approach prevented 32,000 HIV infections and 96,000 HCV between 2000 and 2009. The investment cost of this approach has been 242 million Australian dollars that has lead to an estimated 1.28 billion Australian dollar health care cost saving. Whether viewed through an economic framework, a human rights framework or a public health framework, this approach has been a success.

successful international best practice policies and programs to suit their particular country context. The challenge for the international public health and human rights community is to get the advocacy for the pragmatic approaches right. It needs to be remembered that South East Asia is a public security friendly zone; Thailand has a long history of military intervention in politics, Cambodia is led by a Prime Minister who has a leadership history in a rebel army group, Burma is run by a military junta, the Laos Government is composed of old rebel leaders. In addition, countries in South East Asia are at varying stages of political processes that affects both stability and the institutionalization of a meaningful human rights body that can independently investigate violations of human rights, including those of drug users and in addition press for pragmatic approaches to drug use issues that are grounded in public health and human rights.

Furthermore, the rise and rise of non injecting methamphetamine use poses new challenges to both the public security and the public health communities. Research has shown that non injecting methamphetamine users in South East Asia are likely to report a history of arrest and forced detention, have multiple sexual partners, are likely to use other substances and may have complicated mental health pictures. Non injecting methamphetamine users in Thailand, Laos and Cambodia outnumber injecting drug users by a factor of at least 10 to 1.

The challenge for the public health community in South East Asia is to adapt aspects of 5

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INTERNATIONAL

DRUG USE IS A COMPLEX PHENOMENON AND DOES EVOKE POLARIZED VIEWS AND OPINIONS FROM ALL FACETS OF SOCIETY.

While harm reduction approaches to injecting drug use are gaining limited acceptance and policy responses, the approach to non injecting drug use remains rooted in public security. Despite the fact that in Thailand, Laos and Cambodia drug policies note that drug users are to be treated like patients the reality is very different from the rhetoric. The number of military managed compulsory drug treatment centers have exponentially grown in the last 5 years in Thailand, Laos and Cambodia and recent reports by human rights groups have highlighted significant concerns of these centers and have shown that not only is their operation in violation of multiple UN human rights conventions but in addition, the environment in which people are detained poses significant threats to the health of people detained including growing evidence of prevalent HIV risk behaviour, TB outbreaks, the high prevalence of common skin infections and the lack of evidenced-based drug treatment.

Recently, the violation of human rights in the name of drug treatment has attracted attention from the UN Special Rapporteur on the Convention against Torture who has expressed concern at the growing number of human rights abuses being perpetuated in the name of drug treatment. The UN Convention against Torture is a non-derogable treaty meaning that as a State you can not opt out of your obligations to prevent torture administered at the hands of the State.

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in complex internal state decision making processes versus transparent individual human rights, there is no excuse for a young adolescent methamphetamine user to be arrested, forced into a compulsory drug treatment setting and then to leave that setting with a higher risk of relapse than when he or she went in, or furthermore, to have a higher exposure to infectious diseases than when living in society proper.

Drug use is a complex phenomenon and does evoke polarized views and opinions from all facets of society.

The reality is that a country’s drug policy should not increase an individual drug user’s risk of HIV infection, communicable disease, arrest and incarceration or promote further stigma and discrimination or result in multiple violations of an individual’s right to the highest attainable standard of health. Prioritising individual drug user health is in fact good public health, and ongoing regional advocacy needs to recognize the inherent complexity of the South East Asian public security and public health framework whilst protecting the rights of individuals. We need to understand the complex root causes of drug use and make sure our responses are balanced, pragmatic and grounded in human rights.

Nicholas Thomson can be contacted at nthomson@jhsph.edu

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INTERNATIONAL

ARTICLE DR GEOFF SPURLING DR SPURLING WORKS AT THE INALA INDIGENOUS HEALTH SERVICE IN BRISBANE. HE HOLDS AN ACADEMIC TITLE WITH THE DISCIPLINE OF GENERAL PRACTICE AT THE UNIVERSITY OF QUEENSLAND.

“This is all mine, all these mountains are mine,” claimed Rogelio, describing an arc around this verdant valley of La Montaña de la Flor. “I rule here: I am strong. I don’t need help from the outside.”

I gazed over his valley of thatched roofed houses in the central mountains of Honduras. Rogelio leads one of the few remaining Tolupane tribes isolated from the outside world. The thick forest was interrupted only by the odd cornfield or coffee farm.

I hoped to spray the houses in this last valley to fulfil my brief from Médecins Sans Frontières to eliminate the pretty-winged, beady-eyed, Chagas disease-spreading bug from La Montaña de la Flor. Here the insect thrives in the cracks and thatched roofs of precarious houses, creeping out at night to suck the blood of their unsuspecting victims.

Rogelio wore his traditional dress, the black balandrina , proudly. “Look at my arms,” he said, “I am strong and healthy, my tribe will survive.” A week earlier he had provoked outrage in the local press over his refusal to participate in the national census. Journalists and cartoonists in the capital, Tegucigalpa, lampooned his black dress and poor Spanish. It seemed cowardly to poke fun at this man trying to defend the rights and independence of his pre-Columbian people, who have lived in this part of Honduras for centuries.

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Tegucigalpa, though only four hours’ drive away, is another world, with heavily guarded upper class housing compounds, fast food culture, slums and street gangs.

Chagas disease is like the flu at first, coming on after you scratch the infected faeces of these “kissing bugs” into your skin. The invading parasite then spreads through the lymphatics and makes little nests in all the body’s tissues, especially the heart muscle. Five to 20 years later your heart begins to suffer and you either drop dead suddenly from a rhythm disturbance or gradually pass away with heart failure. A mythology springs up with so many sudden deaths among young adults in the communitythe devil is implicated in most.

The World Health Organisation ranks Chagas disease as the third most fatal tropical disease after malaria and schistosomiasis. It is easily the biggest killer in Latin America, infecting around 17 million people.

A week earlier I had driven into the same mountains to the health centre in San Juan.

Edgardo, the nurse, took me in search of Marcela. Marcela is a Tolupane from another tribe who has three children with Chagas disease. Her husband died unexpectedly two years ago, possibly due to Chagas. Like most mothers in these hills she has lost infants to diarrhoea and pneumonia. The three children were doing well with the anti-parasite treatment until they all came out in the most hideous, drug-induced rash I have seen.

There are only two drugs available to fight Chagas disease - both are toxic and only work in children. The plight of Marcela and her children is not enough incentive in today’s competitive world to stimulate research into better, safer drugs. People with the disease do not have money - they are not a “market”.

Marcela was living in a small one-room shack, the mud-brick walls in disrepair. A damp sack of beans lay almost empty on the floor, which was all she had left to feed the six children sheltering in the darkness from the downpour outside. She had lost her last harvest in the recent drought.

I was relieved to see the rash on each child had made a dramatic improvement, and mentioned that I was planning to return in a week or two with supplies from the World Food Programme. I have seen parents throw tantrums in hospital emergency departments in Australia after waiting two hours for a doctor to see their child. This woman asked me when I might return with food for her starving family with a calmness and dignity that should shame those in the Western world.

INTERNATIONAL

ARTICLE DR HELEN LONGBOTTOM DR LONGBOTTOM IS A GENERAL PRACTITIONER IN BRISBANE. SHE HAS ALSO WORKED AS A FIELD DOCTOR FOR MÉDECINS SANS FRONTIÈRES. In 2004, I stepped aside from my life as a Brisbane general practitioner and spent 6 months in Homa Bay, Kenya working on a HIV/ AIDS treatment program for Médecins Sans Frontières (“MSF”).

A critical part of the work performed by MSF is the engagement in long term treatment programs. In particular, MSF is a leader in the “Access to Essential Medicines Campaign” which ensures the supply of essential drugs for a base price to the developing world. As a result of campaigns such as this, the price of treating a person with HIV/AIDS has dropped from approximately $10,000 US at year to $140 US a year. In turn, this has made it financially feasible for MSF to commence HIV/AIDS treatment programs in places such as Homa Bay. Homa Bay, situated on the shores of Lake Victoria, has a population of approximately 30,000.

In surrounding areas, the population increases to approximately 900,000. In 2004, the rate of HIV in the Homa Bay region exceeded 33%, much higher than in other parts of Kenya. In part, this can be attributed to the traditional practices of the dominant tribe or the area, the Luo. The Luo Tribe practices both polygamy and ‘inheritance’.

The latter is a custom whereby a widow marries the kinsmen of her deceased husband. In a society without social security, this practice serves an important purpose. Notwithstanding, both ‘inheritance’ and polygamy have contributed to the spread of HIV in the area.

Another factor contributing to the spread of HIV in the region was the enormous stigma attached.

As a general rule, HIV is not symptomatic until its later stages when sufferers develop opportunistic infections characteristic of AIDS. Because of the social consequences (and previously the lack

of treatment), people tended not to see early testing as worthwhile. Again this contributed to the spread of HIV in the region and also meant that sufferers were not started on prophylaxis for opportunistic infections at the earlier stages of their illness. The main challenge for MSF in areas such as Homa Bay is to determine the best delivery program for HIV medication. A feature that distinguishes HIV from other infections such as malaria and tuberculosis is its lack of cure.

Because of this, treatment is a life-long process.

Moreover, HIV has a high rate of genomic evolution requiring triple therapy for suppression and daily adherence to prevent drug resistance.

A successful treatment program therefore required an indefinite supply of medication; patient education about the medication, its side effects and the importance of adherence and regular patient monitoring. In particular, it was not uncommon for patients who had stabilized on medication to consider themselves cured and no longer attend appointments. As such ongoing education was essential to ensuring the success of the program. Added to all this was the challenges of delivering patient care in an isolated setting and difficult conditions!

The team I worked with at MSF comprised 5 expatriates (three doctors, a nurse, a pharmacist, a laboratory technician and a logistician) and 50 Kenyan supporting staff. In addition to our HIV program (involving an outpatient clinic and clinics in outlying health centres), MSF was responsible for the male, female and tuberculosis wards at the local hospital.

We worked in challenging conditions. Often there was no electricity or running water. Those needing our care far exceeded our capacity to give it. Wards were chronically overcrowded with patients sharing beds and lying on mattresses on the floor. Despite all this, MSF excelled in its implementation of the HIV/AIDS treatment program in Homa Bay, as it continues to do elsewhere in the developing world. Our patient numbers and treatment adherence rates were very high. Even given recent political unrest in the region, the program has continued. Details of the program can be found on the MSF website (www. msf.org.au). In this regard, MSF truly embodies the ideal that it is not enough to want to do good one must also ensure that they do no harm.

So why become involved in MSF? How do we, as doctors, make a difference? For me, it had been a life-long desire to work in the developing world. As a medical student in 1974, I spent time in Papua New Guinea. This experience brought home the starkly defined needs of communities in the developing world as well as the challenging

and deeply satisfying nature of the clinical work required.

In short, there is a lot of personal satisfaction from getting involved with organizations such as MSF. The “feel good” factor ought not to influence your decision. The ultimate goal of any volunteer work must be to fill a need in a community and improve the qualities of people’s lives. As my experiences in Homa Bay taught me, none of it was ‘about me’.

If working in the developing world is your passion, MSF is a great organisation to join. It requires its volunteers to be well trained and mature such that they provide a valuable contribution to their teams on assignment. Moreover, the organisation has the experience and infrastructure necessary to deliver high quality health care to communities in need. It practises temoignage or advocacy for the disadvantage. Further, MSF is supported entirely by contributions which ensures its independence and that the bulk of its resources are directed to the field.

Notwithstanding, there are other equally meaningful ways to contribute to the community.

My time with MSF was but 6 months in a 33 year career. I found it very hard to settle back into everyday life and, in particular, saw my work in Homa Bay as far more vital than the routine of daily practice as a suburban GP in Ashgrove. In some ways this is true, but it is equally important and satisfying to advocate for and deliver high quality care to my patients here. My days are diverse and challenging. I look forward to the day when I again volunteer for MSF. In the meantime, I am content and fulfilled to being Doctor Helen to a wonderful group of patients in Brisbane.

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INTERNATIONAL

FJN+ & RED PARTY

A NOTE FROM FJN+

HOPE4HEALTH has supported the Fijian charity FJN+ for the past two years. FJN+ (or the Fijian Network for HIV + People) provides medical treatment, training and offers other HIV/AIDS prevention services in Fiji. Currently in Fiji there are over 300 cases of HIV. Although these numbers appear small in comparison to Sub-Saharan Africa, they are still very significant. The President of Fiji, Ratu Epeli Nailatikau made the comment that HIV/AIDS could impact on the Pacific region in a similar way to the impact seen on the African continent a decade ago. [1]

The half way home.

Addressing the issue of HIV in Fiji has been difficult given that education in safe sex is relatively taboo. In response the Fijian Government has drafted an HIV Prevention and Treatment Decree to address these issues.

ADDRESSING THE ISSUE OF HIV IN FIJI HAS BEEN DIFFICULT GIVEN THAT EDUCATION IN SAFE SEX IS RELATIVELY TABOO.

FJN+ has been working strongly to support Fijians affected

by HIV/AIDS since 1995. Through our annual RED Party, the students at Griffith University and the HOPE4HEALTH committee have fundraised for the organization since 2008. Many thanks to Louise Van Camp (MBBS II) for her outstanding effort in running Red Party 2009.

Right is an update from FJN+ that outlines where funding has been sent over the past 2 years.

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The half way home project aims to accommodate people living with HIV who have been exiled from their home and community. The grant received from HOPE4HEALTH has contributed to the completion of the house. Moreover the funding has also supported monthly meetings, food and medication. Funding also allowed for housing utilities including a fridge, double-bunks and cooking stoves.

The half way home project would not be functional without the above material. Therefore HOPE4HEALTH’S financial contribution has been a crucial component to the initiative.

During the initial stage of set up, plans were only to accommodate those who were living with HIV/AIDS who had faced discrimination because of their HIV status.

However, over time we have learnt that the project needs to have the capacity to accommodate other needs of People Living with HIV. Therefore the house also provides housing for our members who require bed rest and for those who are in transit.

More support is needed. Currently there are limitations with regard to the number of people that can be accommodated at once. The house is also not equipped to house couples requiring assistance. Continued financial assistance is also required to ensure that 2 meals a day are provided for our members.

To the students of HOPE4HEALTH, your assistance has enabled an improvement to the lives of our members.

[1] http://www.radiofiji.com.fj/fullstory.php?id=23897

INTERNATIONAL

STUDENT ELECTIVES NATHAN MCCUBBERY, MBBS IV Kompiam District Hospital, Enga Province, PNG Kompiam District Hosptital is a small hospital in Enga province (the highlands of PNG) which is run by an Australian doctor – Dr David Mills- through the Enga Baptist Health Centre. He normally has quite a full regime of Adelaide students each year, but I was lucky enough to be going at a time when he had no other students. Although only a relatively short elective (four weeks) the experience was extremely eye-opening, valuable and something I will never forget.

Getting to Kompiam involved a flight to Port Moresby and a connecting flight on to Mt Hagan which is the closest regional capital. I stayed overnight in Hagan and the following day bought my food for the month and spent about 6 hours in the back of a truck on the long, slow, bumpy ride to Hagan with Dr Mills’ kids and a junior doctor from Adelaide who was spending two months working at the hospital. The hospital is progressing in terms of infrastructure and they now have a new ‘student house’ which was my accommodation for the month.

Kompiam hospital currently has 3 doctors and two wards plus a maternity ward, with a total of about 25-30 beds. A new paediatric ward is slowly being built. Daily activities in Kompiam had a basic structure including ward wounds, designated theatre time and clinic time, although this often was changed with whatever was happening that day. When I was there the hospital had a heavy trauma load- more than half of the patients were either bush knife (machete) wounds (from either tribal fighting or domestic violence), fractures (also mainly from tribal fighting e.g. the back of an axe) or were burns in young children who had fallen into ‘cookhouse’ fires. Medical conditions seen commonly were malaria, typhoid, TB as well as the regular medical problems of pneumonia, gastro and dehydration. The hospital has a lab but no pathologist so no tests are done and all diagnoses are clinical. Pathology is sent to Australia for examination.

The elective definitely allowed responsibility and independence, and gave me a broad practical exposure.

I was encouraged to do everything from assisting and suturing in theatre to taking and developing x-rays. On my second day there I was ‘thrown in the deep end’ as Anaesthetist for an open hernia repair!

Probably the highlight of my time there was going out on patrol. The junior doctor and I went out for three nights with a local health worker doing immunization clinics in small communities in the remote hillsides.

Besides slipping and sliding throughout the hilly hikes on the red dirt/clay, we assisted with immunizations, ran basic screening clinics, did what we could with limited resources and referred anyone with an acute problem to the hospital. The catch 22 with referral in an area like this was that often the patients who most need to get to the hospital are not well enough to make the 2 day or more walk to the hospital and so often do not receive care. Whilst out on patrol we stayed in local grass hut style accommodation and ate with local families (mostly kau-kau (sweet potato) and rice). This was an amazing cultural experience which also required me to use those history taking and clinical skills I have apparently gained in the last four years.

Overall, I thoroughly enjoyed PNG. The team at the hospital and the clinical experience were both great. I would recommend an elective in a place like Kompiam to anyone who wants to get a bit more hands-on medicine, see some new things and challenge themselves. I believe Kompiam is fully booked with Adelaide students for 2010 but if anyone wants contact details feel free to contact me.

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STUDENT ELECTIVES DANIELLE CLARK, MBBS IV Manguzi Hospital Kwazulu-Natal, South Africa.

‘Siyabonga Docotella...’- Thank you Doctor says the patient in Zulu.....After 5 weeks at Manguzi hospital on the northeast coast of South Africa it still feels unreal, albeit exciting, to be playing the role of a Doctor. There are 19 real doctors running this rural 280+ bed hospital. One is an ED consultant and the majority of the others graduated med school within the last 5 years.

The doctors were therefore happy to share however much of their workload students were able or willing to take on...

patients to see as no other doctor would see them that day. Following tea, there is theatre, clinics, OPD. And lastly the 3rd session is more OPD, surgery, clinics etc... It’s true that in Africa you have the opportunity to do a lot.

From day one I was a doctor, and when I had questions I was merely asking a colleague their opinion (from the doctors’ perspective, from my perspective I was screaming ‘Help! Why are you leaving me alone with the patients!’).

There was no wishing I wouldn’t be asked a question on ward round. Despite being as junior as one can get in hospital, I was still helping the overworked staff. I saw my own patients, ordered investigations, wrote prescriptions; was the anaesthetist or assistant surgeon in surgery.

I stuck needles in spines, in fluid filled bellies, lungs and lymph nodes. I delivered babies, sutured, resusced...I was playing Doctor.

Other than being a pseudo-doctor Mon- Fri, evenings and weekends were full of exploring.

All doctors live on the hospital grounds, so there was a brai (bbq) at a house or ‘sun-downer’ by the (hippo) lake or watching the sunset on the water tower. Weekends were spent in nearby Mozambique, on safari (we saw white rhino’s, giraffes, zebras, elephants, buffalo’s and heaps more, but no cats) or out trekking in the wilderness that is South Africa.

Manguzi hospital is a rural hospital serving a Zulu population of over 100,000. There is a male and female medical, male and female surgical, paediatric, maternity, psych and Multi Drug Resistant (MDR) TB wards; Outpatient department (OPD) and ‘ED’; 10 clinics and over 30 mobile clinics, as well as radiology (xray and ultrasound), physio, lab and dental. The patients speak Zulu, with the fantastic nurses teaching you, laughing at your attempt to speak Zulu, or translating for you.

As elective students we had the freedom to choose how we spent our days, mostly spending a week on each rotation to be of some benefit to the staff. A typical day started with the morning meeting where there is handover and a teaching topic. Then 2 hours of ward round. Ward round consisted of 1 doctor, 1 nurse and at least 40 12

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It was an amazing and fun learning experience; however it was difficult to look past the norm of the Zulu people. There ceased to be ‘sad’ cases of HIV, as it was more common for patients to be HIV positive than negative. A headache wasn’t benign, it was TB or cryptococcal meningitis. Chest pain in a pregnant lady was TB pleurisy. A sore hip in a child was TB arthritis.

Any cough and fever was TB or pneumocystis carnii. Bilateral peripheral oedema was Kaposi sarcoma (the beginning stages). Other than TB and HIV there weren’t many other common things occurring commonly.

The upside to this, if there is one, is that it was a pleasant surprise to be in a third world community where there are treatments and resources available. As well as large public health efforts to trace, educate and treat all who need it through the TB and HIV clinic. It seems the rate of HIV in South Africa was increasing because the majority of the population were being tested, not necessarily because the rate of

transmission was increasing. I didn’t see any shame in those who were HIV positive. Those who needed treatment received it and those who weren’t compliant were sought after. If a service wasn’t available the patients were on a bus south to a larger, better equipped hospital. However there were many, many patients with severe disease and not enough resources or doctors to efficiently or optimally care for the community.

The doctors asked if I could purchase textbooks such as ‘The Handbook of Medicine’, ‘Paediatrics’ and ‘Practical fracture management’ with the grant from HOPE4HEALTH. I was slightly sceptical how useful these books would be until I attended my first ward round. There is a great camaraderie amongst the staff, asking questions and learning from each other. It is a fact however, that the onsite consultants were 1 ED physician, the prized textbooks or the telephone.

Prior to arriving at Manguzi I expected to learn a lot without giving much back to the community, hospital or staff. I existed in Manguzi as a fellow Doctor (however pseudo I believed it to be!). I left Manguzi with a great deal of new knowledge.

But I also gave to Manguzi the H4H books which we take for granted. To the staff at the hospital they were a valuable and necessary resource. It showed me however little I think I have to givebe it knowledge, experience or resources, it can be massive to someone else who needs it. For all of this I say ‘Siyabonga H4H’.

OTHER THAN TB AND HIV THERE WEREN’T MANY OTHER COMMON THINGS OCCURRING COMMONLY.

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STUDENT ELECTIVES DAVID SHOESMITH, MBBS IV Kamana Hospital, Tandi, Nepal.

Kamana Hospital is a small 50 bed private hospital in a town called Tandi, Chitwan, in the lowlands of Nepal.

The trip to Tandi was a couple of hundred of kilometres from Kathmandu, but took nearly 7 hours on a slow bus through the windy mountain roads. The bus will drop you off somewhere on the side of the road, and if you’re lucky you will find a horse rickshaw driver who knows where the hospital is.

We stayed in an empty ward on the top floor of the hospital which was furnished with plain old hospital beds and a stainless steel table. There was a fan in the room that was fantastic if the power was on; a big problem in rural Nepal.

Kalimati clinic is in the Tanahun district of southern Nepal, and is another 4-5 hour drive up in to the mountains from Tandi. It serves around 50,000 people who live and work in the remote hillside areas around the clinic. It is run entirely by people’s participation over the past 8 years, and has been completely funded for the past year by Dr. Arjun Pant. As the Kalimati clinic is entirely a charitable unit, it is largely run by community midwives and local ‘paramedics’ and clinic assistants.

They were extremely pleased with the donation from the $500 HOPE4HEALTH grant, as it would fund the clinic to run for another 8 months.

Medical care throughout the country is substandard compared to Australia. Although there are good facilities in the major towns and cities, rural areas are sorely neglected. This is compounded by the high incidence of disease, poor sanitary conditions and inadequate immunization programs.

Due to the remoteness of the Kalimati clinic, we spent most of out time in Tandi. Our days were divided between the Kamana hospital, various small clinics, and the local government hospital. The main complaints and presentations to any clinic was usually fever, cough, or abdominal pain. It was very interesting to see the variety of pathology that presented, as it was very different to what we get in Australia. We saw a lot of Enteric (typhoid) fever, Kala-azar, TB, malaria, a huge range of dermatological disease, Tetanus, and more. Due to the poverty of the majority of the people, diseases were

fairly well advanced before they presented to hospital.

Generally they would try the local village cure, then they would see a pharmacist (4 week college course), who would generally prescribe an irrelevant medication. Then people would be desperate enough to go to the hospital or clinic. The majority of clinics and hospitals are private, and a consult would cost less than a dollar. But that is a huge amount to most people there.

Unfortunately, there was a major language barrier, which made it difficult to see patients alone, but the doctors were very happy to act as interpreters. Due to the cost of investigations, which most patients could not afford, we learnt to depend on history and examination skills to diagnose. Procedural hands on experience was not common either, as anything too serious would be transferred to another hospital in the next bigger city; if the patient could afford an ambulance. We also had the opportunity to visit some of the local schools and give small talks on influenza, swine-flu, and proper handwashing techniques.

All the medical staff are fluent in English, and were more than happy to have students to teach. They were very keen to learn about how things work in Australia. People on the street were also very friendly and fairly honest, but you still had to barter for most things. As we were staying in a fairly rural area, there were no other foreigners to be seen the whole time of the elective, except when we went to the tourist area near Chitwan National Park. It was very interesting to see people’s reactions. Most were very excited to talk to a foreigner.

I would definitely recommend an elective in Nepal to anyone who has an interest in tropical medicine or infectious disease. It was a most enjoyable experience that I would gladly repeat.

ALL THE MEDICAL STAFF ARE FLUENT IN ENGLISH, AND WERE MORE THAN HAPPY TO HAVE STUDENTS TO TEACH. THEY WERE VERY KEEN TO LEARN ABOUT HOW THINGS WORK IN AUSTRALIA.

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STUDENT ELECTIVES BRIDGET GILSENAN, MBBS IV Samoa I first heard of Samoa as an elective option during my second year of medical school from a group of University of Queensland medical students. The idea of hands-on medical experience in an idyllic ocean paradise sparked my interest, and the promise of great surf cemented the deal. Two years later, with my sights set firmly on exposure to Obstetrics and Gynaecology in a country with a ridiculously high birth rate, I set off with my surfboards in tow.

The first couple of weeks went according to plan. I spent weekdays in the hospital helping with prenatal and gynaecological clinics, attending births, and assisting (holding stuff) in theatre. The medical team at the hospital was amazing. Despite the fact that they were incredibly overworked, underpaid and under-resourced, they never passed up an opportunity to teach both foreign and Samoan medical students. Moreover, due to lack of facilities (there was no working ultrasound machine in either the emergency or O&G departments) the Samoan doctors were consistently required to think on their thong-laden feet. And it was to my constant amazement how well these situations were handled with a smile. After hours the same doctors and medical students became friends with compulsory touch football and after-work beers.

The weekends were similarly enjoyable. I spent them surfing on the South Coast and enjoying perfect left hand reef-breaks with knowledgeable surf guides and funny kiwi surfers. It would be an understatement to say that I was enjoying my time in this ocean paradise, surrounded by lovely people. I basically spent everyday participating in my favourite activities, all in the comfort of my trusty Havianas.

Nearly halfway through my elective the Tsunami hit and everything changed. A group of us were about half a kilometre up the hill from where the Tsunami hit, preparing to go surfing, when the earthquake struck. Our mountain home quickly became a refuge of sorts, as the south coast villagers arrived to a place where they knew they would be welcome. Fortunately, the beach that we considered home (Maninoa) did have a Tsunami warning system in place. Everything in Maninoa was completely wiped out including two high-end hotels, but no lives were lost there.

The situation was not so fortunate at a nearby village, Lalomanu. Our surf guide received a phone call explaining that his friend’s daughter was missing, and 14

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as we drove to Lalomanu with the canoes on the back of the pick-up truck, I must admit that I experienced a little bit of internal anxiety. It dawned on me that, despite my very junior status in the medical community, this group of non-medicos might soon be looking to me for answers.

The police had blocked off the road to Lalomanu, for fear of further after-shocks and subsequent Tsunamis, so we couldn’t get through. We decided that I should go to the hospital, to see if I could help, and the minipanic surrounding my lack of medical experience returned. I did not know if I would be at all helpful. My anxiety was quickly relieved when I realised that the emergency department was becoming inundated with local and foreign senior doctors. All non-urgent hospital departments had been shut down and their doctors and nursers ordered to the ED. The department also became a Mecca for holidaying foreign doctors who promptly arrived to offer their services. I breathed a sigh of relief as myself and other medical students were directed to wound dressing, scribing and orderly duties.

The most common complaints presenting to the emergency department in the days following the Tsunami were: wounds, fractures, aspiration pneumonias and death. It was especially difficult for us foreign medical students because we didn’t speak Samoan. This language barrier had previously been relatively small as the official business language of Samoa is English. However, in a disaster setting, when attempting to comfort those who had lost loved ones whilst you are cleaning their wounds the barrier was often insurmountable. This was especially so with children. We did what we could and what we were instructed to do by the senior doctors. But I think we all felt that we weren’t as comforting as we would have liked to have been.

In the following days the Australian and New Zealand medical teams arrived with a complete hospital in tow (!). It was becoming clear that foreign medical students were no longer needed (or wanted) in the emergency department. By chance I ran into an Australian friend who was a medical student at the local medical school Oceania University of Medicine (OUM). He invited me to join the team that was providing mobile medical care to villages affected by the Tsunami.

After the first day the team quickly realised that it was not just wound dressing, antibiotic cover and tetanus shots that the people required. A large number of Samoans, a people known for their impressive size, had lost their

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IT DAWNED ON ME THAT, DESPITE MY VERY JUNIOR STATUS IN THE MEDICAL COMMUNITY, THIS GROUP OF NON-MEDICOS MIGHT SOON BE LOOKING TO ME FOR ANSWERS.

anti-diabetic, anti-hypertensive and other regular medications in the Tsunami. One poor guy lost all his colostomy bags. These losses were compounded by the fact that the pharmacy was an hour away from the south coast. Most people had lost their vehicles and livelihoods in the Tsunami. Such difficulties prevented some from accessing care, whilst others felt that their wounds or complaints were too minor to warrant treatment. For these patients, mobile medical teams were a welcome source of health care and support.

In total, the OUM Team completed over 300 consultations in the two weeks following the Tsunami. The majority of these were for: wounds, tetanus cover, upper and lower respiratory tract infections, medication replacement (diabetic and hypertensive medication mostly), and childhood illnesses. Luckily, feared outbreaks of disease such as typhoid, diarrhoeal disease, dengue fever and measles did not materialise. This was largely due to the common sense shown by the Samoan people in their food and water preparation. There was an impact from newly overcrowded living conditions but this largely manifested medically as upper respiratory tract infections and scabies. I have never seen so many children with scabies and impetigo. Fortunately a lower than expected incidence of wound infection was seen, and no cases of tetanus were reported. This may have been partly due to the efforts of the numerous medical teams who worked tirelessly to prevent such complications.

In the weeks following the Tsunami, the OUM team (Senior Samoan doctors supported by Samoan and international medical students) became a very tight-knit group. It was interesting to see how working in such a unique setting (i.e. constantly surrounded by farm animals and very cute children) and encountering various obstacles (flat tyres (x3), bogging (x4), lack of equipment) could be such a great bonding environment. The excellent team dynamic was supported by the unfailing sense of humour and dedication possessed by all team members.

I must admit that it seems quite strange and almost disrespectful, to reflect so happily on a time that was so tragic for so many people. But in my mind, both perspectives are entirely valid. It was quite surreal at times to be laughing hysterically in the team van on the hour journey to the south coast, only to be faced with some harsh realities just ten minutes later. You would walk up to a makeshift tent where a lovely smiling family would greet you, only to realise their sorrow as you notice four enlarged photos of gorgeous, smiling and nowdeceased children. It was definitely a time of contrasting

emotions. The not infrequent Tsunami warnings up to two weeks post-Tsunami also reminded us of the situation.

These last thoughts lead nicely into a question I was asked to answer for this article: “How has this experience changed you”. Well, that’s a difficult question to answer without sounding like a bit of an idiot. For all appearances my life will continue roughly as it has been as I embark on my year of internship. However I do think that some things have shifted in my mind. When you see entire villages destroyed and see friends who have lost their children, it really does make you realise what is important to you. Family, friendship and laughter were the winners in my mind. Funnily enough I began to doubt the importance of fashion and notice how boring TV really was when you compared it to real life.

Professionally, I have begun to feel very strongly that I wanted to become a highly skilled medical specialist.

It was eye-opening to see the impact that the visiting Australian and New Zealand specialists could have in a place such as Samoa in just a week or two. To attain a level of skill and expertise that you can share with places such as Samoa for a couple of weeks, or a month, each year of your working life would be a privilege.

So what would I say to students considering an elective in Samoa? The Samoan people are just great. They are warm, friendly, polite, hospitable and above all, infectiously happy. The doctors are no exception, although the words intelligent, practical and hard working should be added to the description. Samoa is a great place to see things in medicine that are bigger and better than anywhere else (e.g. “That’s the biggest carbuncle/ chocolate cyst/Bartholin’s cyst/tumour/baby I’ve ever seen!”). For junior doctors, it is a place where there are great opportunities to learn if you are willing to seek them out. Senior doctors visiting the country also enjoyed their time assisting and providing further professional education to the grateful Samoan and international doctors working full-time in the national hospital. I only hope that one day I’m lucky enough to be one of those visiting specialists that can practice medicine in Samoa… in my trusty thongs*!

* Note that one should be careful using the word thongs in Samoa, as most of the visiting foreigners are from New Zealand, where this word has a different meaning. One learns very quickly to start using the word jandals unless you want to be constantly smirked at!

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PROFILE PROFESSOR SIMON BROADLEY Biography: Professor Simon Broadley is the current Dean of Medicine at Griffith University. Professor Broadley also holds the position of Staff Specialist in Neurology at Gold Coast Hospital.

Can you describe your career path that has taken you to where you are today?

My story starts in School, which I did just outside of Manchester. I applied to and managed to get in to Manchester Medical School which also happened to be the biggest medical school in Europe at the time. There were 250 in each year. At Manchester I did what was eventually 6 years with 5 years of a medical degree and an extra BSc in Immunology taking 1 year. I did what was my equivalent to an internship in Lancaster and Manchester. Initially I had set myself up to become a surgeon, but I soon changed to do Medicine once I began practicing. I did SHO jobs which were equivalent to basic physician training in Manchester and then Liverpool and when I came to the end of that I did my MRCP exams. During this time I was doing neurology and thought ‘I like this’ so I decided to pursue neurology.

I then did my advanced training in Neurology and became a specialist registrar in Neurology in Bristol. I then did my PhD in Cambridge with Alistair Compston on the genetics of MS. During this time I met my wife who happened to be from Brisbane. We had what must have been a 10 second discussion about where we should live (England or Australia) and for some reason Australia won. So then I applied for jobs in Australia and got a job in Adelaide as a registrar.

I finished off my training in Adelaide, then went back to Bristol so that my training would be recognised in Australia, then came back out to Adelaide and got it all finished off here. So I got my FRACP. And then I applied for the job of the Year 3, 4 co-ordinator at Griffith University.

It was exciting setting up a new medical school. I’d not been involved formally in academia before but I had always been involved in teaching medicine at every level throughout my career. I had always had an interest in both academic neurology and the teaching of Medicine. So I got very involved in setting up the medical program at Griffith right from the start and I have loved doing that ever since. Last year I was made acting Deputy Head of School and then Deputy Head of School. This year I applied for and got the job as Head of School and Dean of Medicine.

What aspects about your job are you passionate about?

With Neurology I enjoy the diagnostic challenge of things.

There are a few common things that you see in Neurology but there is a whole host of weird and wonderful things that you also see. The clinical challenge and the solving 16

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of complex puzzles really intrigued me to begin with. But over time the thing that you begin to appreciate, which is much harder while you are training, is the aspects of long- term care. Often in Neurology you are dealing with long-term illness, and that obviously has great rewards over time. This includes getting to know people and hopefully influencing positively their experience of whatever disease they might have. And while some people might view some of the conditions that we deal with in neurology as rather depressing, I think in practice I have found it a very humbling and enlightening experience. It is an honour to deal with people who have to face greater challenges and adversities than what I have had to face. It is also admirable that often these patients meet all their challenges with positive attitudes and great humour.

My interest in Multiple Sclerosis was originally a bit of a coincidence. I have always had an interest in genetics from a sort of concept point of view. I also had a background in Immunology. Just by chance there was a potential for me to go to Cambridge to study Multiple Sclerosis (which is an autoimmune disease) so it all made perfect sense.

Medical Education has always been a passion and interest for me throughout my training. But it is one of those things that you have to be careful about in Medicine because everyone thinks they can teach. I’d like to think that I have insight into avoiding those stereotypes and trying to apply some vigorous practice to what we do here at Griffith.

However in terms of clinical education it is largely an evidence free zone. There are lots of opinions, but not very much hard fact. I think certainly what we have done here is to try and base our decisions on evidence as much as possible as well as taking wide advice on what we have done.

What is the potential for a Rural Clinical School at Griffith University?

Griffith would very much like to meet the needs of our students, the State of Queensland as well as pressures from outside in terms of what the AMC would like us to offer with regard to a fully rounded medical program. In terms of offering more placements we appreciate that they are very limited. This is due to a previous lack of availability for rural placements due to competition nationally. However, we are very keen to pursue rural clinical placements for our students and will continue to do so over the coming years.

We already have a number of selective terms available (for 4th years), and the students have been very proactive in setting up certain collaborations in Toowoomba and elsewhere throughout Queensland Health and Gold Coast Hospital in particular. This includes the exposure that students have had at Cherbourg. So it is building up slowly, but we definitely intend to expand in the future.

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My own preference is for rural terms that will be for substantial periods of time and not just a few weeks.

Something along the lines of the Riverlands experience that Flinders uses is a great model to follow.

The shortage of rural clinical places for students is like one of those Catch 22’s. The need across Australia is for greater access to health care in rural settings because of a shortage of not just doctor’s, but allied health and nursing staff. But when it comes time to offer places for students in those areas, it is problematic because there are so few potential supervisors. We are exploring a lot of potential solutions.

What sort of challenges do you believe that the Medical school at Griffith University may experience over the next few years.

YOU WOULD HOPE THAT OUR GRADUATES WILL FEEL A SENSE OF BELONGING AND A DESIRE TO GIVE SOMETHING BACK SOMEWHERE DOWN THE TRACK.

The main ones are to ensure that we can maintain good quality clinical placements and to provide some degree of flexibility and spare capacity in the system so that, for example, when a clinician falls ill, and support for students in an area falls over effectively, we have alternatives. At the moment there is very little spare capacity. The system is working, and it works very well for the most part. But we are very vulnerable to those kinds of disturbances that are going to happen from time to time. So we need to pursue other options and one of those is obviously rural placements.

But we need to also think about what else we can do and that involves engaging with the private sector, which is problematic but not impossible. We have already done that with the Wesley and that’s going very well. So we have to look at implementing that model elsewhere.

We need to continually twig the program and look at areas of deficiency. The two that everyone keeps telling us about fairly universally from both clinicians and students, is pharmacology/applied therapeutics and microbiology. Again they are both difficult areas because you can teach people a lot about microbiology and pharmacology, but it is actually a very different matter when it comes to it’s application. For

example, it’s a bit like the calls from surgeons saying that we do not teach enough anatomy. It is not that we don’t teach enough anatomy. It’s because the way in which you apply it is different to the way in which an experienced surgeon will apply it. It’s not that you don’t know it.

So some of the apparent discrepancy is simply on the ability to apply knowledge. Also we recognise that there probably is a bit of a deficiency in those areas. One of the things we are really keen to pursue is promoting the application of knowledge in some sort of virtual setting so it is safe to actually practice what you know. And the obvious examples of this are the SCIMS week that we are currently running.

SCIMS week now has a high fidelity so it makes people think in the same ways as they would in a clinical environment.

And it allows them to make those clinical decisions that they are going to have to eventually make for real in a couple of years time.

What sort of impact will having alumni of Griffith Medical School have on the School itself?

You would hope that our graduates will feel a sense of belonging and a desire to give something back somewhere down the track. That can come in lots of different ways, whether it be in teaching our students, enhancing the reputation of the University and medical school, being involved in research projects down the track or just doing good work out there. You would certainly hope that we will be able to keep some kind of positive relationship with our former students. I think that will be a very good outcome of any alumni association.

What sort of legacy do you want to leave?

In some ways I have achieved everything that I could hope to achieve in life, both personally and professionally. And being the Head of Medical School, doing the research that I have done and I am doing currently, has brought fantastic rewards. To have publications in Nature Genetics with your name on it, you can’t hope for anything more then that. To be also moving very slowly toward effective treatments for MS is something you don’t really anticipate in life as to ever seeing.

And although my contribution to that is very minimal, you do feel very much a part of it. I am also hoping that we can help grow the reputation of the medical school and enhance its research profile. Not just personally but as a collective medical school. That we can develop the Griffith School of Medicine into the flourishing environment it deserves to be.

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H4H CLINICAL SKILL WORKSHOPS Since starting my degree in this new era of self directed learning I have discovered that I can learn a lot of medicine through books and “credible” online resources.

There is one vital aspect of medicine that you cannot learn through reading a book, clinical skills. As quoted in the considered bible of clinical skills Talley and O’Connor, “medicine is learned by the bedside not in the classroom.”

Recognising this, in 2008 Catherine MacManus started the HOPE4HEALTH Clinical skills program. The program involves a series of workshops that build on the Griffith School of Medicine curriculum. The workshops involve students with clinical experience teaching clinical examination skills to other students. They not only provide students with an opportunity to practice their clinical examination skills, but an opportunity to gain pearls of wisdom from other students.

Who can forget such pearls as Marty’s 4 S’s to approaching clinical examination, “ have a Structure, keep it Simple, be Slick and you will have Success.”

The HOPE4HEALTH Clinical Skills program has been well received by students, and is extremely popular. At the 2009 Griffith Student Guild Awards, the HOPE4HEALTH Clinical Skills Workshops won the award for The Best Cultural Event of the Year. On a personal level, having just recently completed my OSCE examination I was extremely grateful the workshop sessions. Although I did not remember the exact steps to preparing a bag of saline for fluid resuscitation, I resisted the urge to hyperventilate and run out of the room.

Instead I followed Marty’s directions and kept it simple, followed a structure, tried my best to appear slick, and was somewhat successful!

As part of my role as Vice President I had the pleasure of running the 2009 Clinical Skills program. Due to the popularity of the 2008 workshops this year we expanded the program, adding additional clinical examination topics and doubling the number of sessions so that more students could attend. The success of the workshops is largely due to the presenters and tutors that volunteer their time (which is often extremely precious in the life of a medical student) to help run the workshops. I would like to take this opportunity to thank them, and the staff at Griffith School of Medicine for making this year’s program such a success.

Alix Longbottom (MBBS II) was the Vice President of HOPE4HEALTH in 2009.

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THE TEDDY BEAR HOSPITAL PROGRAM, GOLD COAST The Teddy Bear Hospital was created and is run by HOPE4HEALTH volunteers. It is a preventative health program that aims to encourage healthy living in primary school aged children around the Gold Coast. A specialised program also runs at Cherbourg Primary School. Workstations at the Teddy Bear Hospital currently include ‘Being Sun Smart’, ‘What happens when you visit the doctor’, ‘Healthy Eating’, ‘Dental Care’ and ‘Healthy Exercise’.

The program is incorporated into the Griffith University medicine curriculum for first year students.

Approximately 70, first year students participate at the Teddy Bear Hospital throughout the year as part of their community placements. Many volunteers also come from older year levels who take time out of their busy schedules to help coordinate what can be a very busy day.

I have often volunteered for the Teddy Bear Hospital and was a part of its creation back in 2007. For me it was my first exposure in public and preventative health and the experience gave me additional skills in communicating with children. The Teddy Bear Hospital has also been a real eye opener with regard to how relevant even grassroots, preventative health programs can be.

The Teddy Bear Hospital is run by a team of volunteer students who are responsible for the organisation of the many Teddy Bear Hospital visits that take place each year. In 2009, Lucy Francis (MBBS II) led this team brilliantly. I hope that students in years to come will embrace this program as something that is theirs to continue and develop.

Claire Cuscaden (MBBS IV)

INDIGENOUS

PROFILE PROFESSOR JONATHAN CARAPETIS Biography: Professor Jonathan Carapetis is the Director of the Menzies School of Health Research that is based in the Northern Territory. Professor Carapetis is a medical practitioner, paediatrician and specialist in infectious diseases and public health. His research in group A streptococcal diseases in the Aboriginal population led to the establishment of Australia’s first rheumatic heart disease control program in the Top End. He co-founded the Centre for International Child Health at the Department of Paediatrics, The University of Melbourne. Professor Carapetis’s research is entirely focused on the health of Indigenous people and those in developing countries.

What was the pathway that you took from medical school to becoming the Director of the Menzies School of Health Research?

I graduated from Melbourne University in 1986 with a Medical Degree and also a Bachelor in Medical Science. I did an internship at the Royal Melbourne Hospital and followed that up with a Junior Resident year also at the same hospital. I did this because I felt it was important to get two years of adult exposure before heading into Paediatrics. In my third year I moved to a Junior Resident job at the Royal Children’s Hospital in Melbourne and worked there for that one year. In 1990, I took a year off to travel and relax knowing that I would then be coming back to launch into study for specialist exams. I had a great year off spending a lot of time in France and seeing the world. I think I worked for a total of three weeks for the entire year and came home to Australia in debt but happy. I returned to the Royal Children’s Hospital in 1990 where I stayed for 4 years. During this time I passed my Physicians exams to become a Paediatrician and did my first advanced training year as Fellow in Paediatric Infectious Diseases. In I994, I moved to Darwin to start PhD studies at the Menzies School of Health Research looking at Rheumatic Fever and Rheumatic Heart Disease in the Aboriginal population. This took about 4 years and I incorporated the finishing of my Paediatric, Infectious Diseases, and Public

Health training. I spent a year in 1998 – 99 in Canada undertaking a Clinical Fellowship in Infectious Diseases in Toronto. I did this because I wanted to spend a year away from research and I also felt that this would augment my clinical training in Infectious Diseases. I returned to Melbourne in 1999 because of the opportunity of working with a colleague, Professor Kim Mulholland, to establish something big in international child health. I worked as Consultant in Paediatric Infectious Diseases at the Royal Children’s Hospital in Melbourne, but my main position was as Senior Lecturer in the Melbourne University Dept of Paediatrics.

I spent 7 years in Melbourne. During this time Prof Mulholland and I established the Centre for International Child Health. The Centre worked mainly in the Pacific region. I also maintained my connection with Menzies and did a lot of Aboriginal Health research out of the base in Melbourne. In 2005, I was informed that the Menzies Director position was coming up.

Initially I didn’t think twice about it, thinking that someone like me wouldn’t have a hope of such a job – the two previous directors were very illustrious. But I was convinced to throw my hat in the ring – I agreed, just to get the experience of applying for a job at this level. One thing led to another and I was offered the position and chose to accept it. I haven’t regretted my decision for a minute.

You were mentored by Professor Bart Currie.

How important was this relationship in developing your career interests? What were other influences in your life that impacted on your career choices?

I came to know Bart Currie when I was a medical student and he was a registrar at the Royal Melbourne Hospital. Through him I became connected with a wide group of liberally minded doctors and medical students in Melbourne and we were active in organizations such as People for Nuclear Disarmament in the 1980s. I reconnected with Bart in 1993 when I was considering PhD options and found that he had, after a period in Papua New Guinea,

moved to Darwin. He mentioned that there was a need to sort out the issue of Rheumatic Fever in the Aboriginal population, I flew up to chat with him, and the rest is history. I consider Bart a mentor, a hero, and a friend. He’s incredibly hard working and an inspiring individual. Above all he focuses on being a good clinician and this informs every aspect of his research. There is no doubt that he has been a great inspiration in keeping me involved in Aboriginal Health and fostering my interest in Public Health. Other mentors include Prof John Matthews who was the Director of Menzies and a co- supervisor of my PhD along with Bart. A truly honourable and gentle man, John is brilliant and very devoted to Aboriginal Health. Probable the other big influence that affected my career choices was being exposed, at a relative young age, to issues in developing countries. My father worked for the World Bank and we moved to Washington when I was in high school. I spent 5 years there and for that period, and a number of years afterwards, learnt a lot about developing countries issues, particularly in Africa. I became aware of a whole realm of problems related to equity and poverty in developing countries and how we have a responsibility, in affluent society, to do what we can to address this imbalance. I think this has been the major motivation behind my career choices, directing me firstly to Child Health, then to Infectious Diseases, and then to Public Health. These are the skills I use to tackles issues of poverty and inequity. Pretty much all the work I do relates to dealing with developing countries and Indigenous Health.

Were there other careers that appealed to you at Medical school? Has your career turned out as you envisioned it?

To be honest I wasn’t even sure that I wanted to be a doctor when I started at Medical School. I guess I was young and reasonably smart and probably only considered careers such as Law, Engineering, and Medicine. I had always had a bent for biology so medicine seemed to be an obvious choice. I enjoyed Medical School but I can’t say I threw myself into it until the clinical years from 4th year onwards.

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I had a pretty good perspective and realised that, in the Melbourne University course, the first 3 years counted very little toward one’s final mark in Medicine. So I went from being a straight A student in High School to having a significant number of passes on my university report card in the preclinical (first 3) years. But I managed to combine those pass marks with a fantastic time socially. I became very involved in a number of semi political organizations involved in nuclear disarmament, and doing lots of student theatre.

A defining moment of my student years came in 1984, when a group of fellow student actors who had performed with me in the Melbourne Uni Law Revue decided to take the year off studies and tour a national revue, a bit like Cambridge Footlights.

I thought very carefully about joining them, but in the end decided to try a year of research (that was my B Med Sci year). This was the start of my research career. However, if I had taken the other road… Those other students went on to become the D Generation, Fast Forward, to make The Castle, The Dish, Kath and Kim, Thank God You’re Here, and the list goes on. Do I think I made the right choice? Probably, because I am realistic enough to know that I wasn’t as good an actor or comedian as them. But there is a part of me that always wonders…

University was in many ways responsible for many of the best years of my life. I then threw myself into Medicine once we started to see patients in our Clinical year. That was when I discovered how much I enjoyed Medicine and how much it could lead me in the direction I wanted to take.

I’m not sure that I’d every envisaged any particular career in Medicine. I always have trouble planning more than 5 years in advance. I certainly found out during my medical course that I enjoyed research, having done a Bachelor of Medical Science. In many ways this changed my entire way of thinking and made me realize that, no matter how little I knew on a subject, by working from first principles I could always say something sensible about anything. It made me a lot less daunted by the entire Medical curriculum. I returned to research during my PhD and I really consider research to be my major medical career, although I’m still a clinician at heart and am very active in clinical medicine. I think that clinical medicine really augments my research, gives me perspective and credibility, and allows me a whole lot of research options which I would not have if I had not remained a clinician. When I eventually became a consultant I realized I had interests beyond just doing good research and being a good

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clinician. I felt I could make a bigger contribution by taking a leadership role particularly in mentoring the young researchers of the future.

Hence my evolution to become Director of the Centre for International Child Health and now the Director of Menzies. Although these decisionmaking jobs can be quite stressful at times, they can also be incredibly rewarding when you see young researchers get grants, degrees, major publications, and make important contributions to health outcomes.

What do you find most difficult about working in Indigenous Health? What do you find most rewarding?

Well, Indigenous Health is undoubtedly difficult and rewarding. The biggest difficulty is the overwhelming nature of the problem. It is easy to become daunted, indeed paralysed, by the fact that dramatic changes to Indigenous health require, in the end, resolution of poverty, improvement of living conditions, improvement of educational outcomes, resolution of unemployment, and the swag of social and political changes that those things entail. That can be disheartening. So one has to focus on the things one can do, and yet at the same time retain the big picture. The politics is also frustrating and annoying. Working in Indigenous Health, one has to cope with a range of very strong viewpoints, many of which can be expressed in hurtful ways. But you have to focus on the positives, and the bits (however small) of progress. The best feedback I ever get is from people on the ground in remote Indigenous communities – when they tell me how much they appreciate the work I do, it counts for more than any negative comments the gatekeepers might hurl. I guess the most rewarding thing about Indigenous Health is that you’re working in perhaps the area of greatest importance in the Australian health scene and no moment is wasted.

Can you tell me a little about your work linking education and child health outcomes?

When I returned to Menzies as Director three and a half years ago, I challenged the staff of this organisation to think a bit more broadly about health then they had in the past. Menzies has a fantastic reputation for doing very good biomedical research, and work that is focused on diagnosis, prevention and treatment of disease.

But the reality is that the roots of the poor health outcomes are largely beyond the health sector. It is the big four: poverty, education, unemployment and housing. I said to the staff that if these four things are the real determinants of health then

they are, by their very nature, health issues and we as health researchers have a duty to try and tackle them. It is difficult to decide which of those four you want to tackle first but, to my way of thinking, education is an obvious one. If there is one single thing that would make the biggest difference to Indigenous health and wellbeing, it is giving Indigenous children a good formal education. So we have partnered with education researchers to begin a program of research looking at child development and education.

This is certainly incredibly promising in its early stages, including our success in getting a major National Health and Medical Research Council grant to evaluate the mobile preschool system in the Northern Territory. We have also partnered with the Northern Territory Education Department to evaluate their entire program of Indigenous education initiatives. I think health researchers can be welcomed in the education research field as long as we accept that we are not experts in the content, but can make contributions in terms of family functioning, in child development, and in terms of the research methodology we have expertise in.

What sort of advice would you offer medical students who want to pursue a similar line of work to you?

Above all get a good basic training in medicine and preferably some sort of specialist training that is of relevance, whether it is a clinical speciality, public health, research or a combination of the above. Start making connections and get interested in the area in which you want to work now (e.g. Aboriginal or International Health) through various interest groups and perhaps through travel and work experience in those settings. Talk to people who have worked in those areas and find out about the range of career paths that could lead you to make a contribution. But above all, enjoy yourself and don’t make plans that you can’t change. You’ve got a long life ahead of you and there is no hurry. I didn’t start my PhD until I was 33 years old and I didn’t get my first consultant job in a hospital until I was 38, and it is not as though I didn’t have a great time in the mean time. So be patient and flexible. In terms of being flexible I mean that if good opportunities come up feel free to take them even if they diverge from a path you may have set several years ago. No one’s life should be run according to a strategic plan. That’s how we run organizations, not our own lives. Make sure that you take time off, travel, indulge yourself in the things you get the most fun out of, and don’t compromise your principles.

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A LEARNING CURVE IN INDIGENOUS HEALTH Walter Hipgrave is a second year medical student. He organised the HOPE4HEALTH Indigenous portfolio in 2009. In 2010 Walter will take on another challenge as President of HOPE4HEALTH. Indigenous Health is a challenging area of medicine that involves far more than physiology, pharmacology and surgery. It requires knowledge of Australia’s past and present history, understanding of Aboriginal culture and the ability to confront your own prejudices and shortcomings. The reason why I applied for the Indigenous health portfolio was not because I knew a great deal about Australian history or Aboriginal culture but because I wanted to learn more about our country and take the opportunity to support the dispossessed traditional owners of this great country. I came across three strategies that I thought our members could aim towards as a way to improve Indigenous health. The strategies were: 1. Improving cultural awareness and understanding 2. Promoting primary health care and disease prevention 3. Encouraging Health careers among Indigenous Australians The first project for 2009 coincided with the national ‘Close the Gap’ day on April 2. HeartLands was the first, and hopefully not last, Indigenous Art Exhibition to be organised by HOPE4HEALTH. Held in the waiting room of Specialist Connect, a medical centre in Wooloongabba, we exhibited some fine art created by established and emerging Indigenous artists. Robert Barton, Laurie Nilsen, Jennifer Herd, Bianca Beetson, Ricky Morgan, Karen Taylor and Jenny Fraser all contributed to the exhibition. The aim of the evening was to bring attention to the gap between the life expectancies of Indigenous and non-Indigenous people and promote awareness and understanding of Australia’s Indigenous culture. The Aboriginal art industry provides new and exciting ways of communication that will help bridge the cultural

divide between Indigenous and non-indigenous Australians. On the opening night we were gifted with presence of elder Delma Barton who gave a stirring welcome to country with a song in traditional language. The exhibition was a huge success and in between canapés and refreshments seven paintings were sold to a total $4500. The challenge is now to find ways to continue and build upon this event for the future.

HOPE4HEALTH has been working with Barambah Regional Medical Service in Cherbourg for a few years and 2009 grew this relationship by building upon our bi-monthly visits with specialists from Gold Coast Hospital and the development of a new dental program. After discussions between the School of Medicine and Barambah Medical Service we decided, in order to improve the student experience we would expand the visit from a difficult 14-hour single day to a more manageable two-day program. The bi-monthly visits to Cherbourg allow our student members to experience first hand specialist consultations and observe Indigenous health in action. The two-day program included cultural awareness training by visiting the historic Ration Shed museum and Cherbourg Hospital, and tours of the township with an overnight stay in Murgon.

This gave students a better chance to experience Cherbourg and be more prepared for the specialist consultations. The new dental program is being developed by Tessa Byrne (the 2010 Dental Representative) and will see the start of dental health checks being provided by Griffith students with the long-term goal of helping build a permanent dental clinic at the Barambah Regional Medical Service. The other student placement that HOPE4HEALTH organises in Cherbourg is the Teddy Bear Hospital Outreach program where Griffith University students spend a day with primary school students. We ran interactive tutorials that were heavy on the fun but not light on the promotion of healthy living and eating. Usually we only work with grades 1 and 2 but we also wanted to do something for the older students who were about to begin high school. We came up with the unimaginatively named ‘Health Careers Expo’ for the grades 6 and 7 to give a small taste of what happens in health careers.

It is hoped that the expo will help to sow the seeds that may produce some doctors, nurses or dentists (and more!) of the future.

due to the close proximity of exams (they always get in the way of a good time) but allowed H4H to reward our fantastic professional helpers. I really hope that our presence at the Dreaming Festival can continue and that in future years we can generate more student interest. The second festival was the Deadly Days Festival held at the Kingscliffe Tafe College. This event was aimed at getting students to think about their health, their future careers and the opportunities available.

Armed with ‘Resus Annie’ (a CPR dummy) we taught the basics of emergency resuscitation and told people about studying medicine and the support structures available to Indigenous Students at Griffith University.

With such a successful growth of the Indigenous portfolio, how can we improve and expand on this? Well, 2010 will begin with a Dreaming tour of the Gold Coast to encourage the new student cohort to learn about Indigenous culture and start thinking about the being involved in Indigenous health. It will also see the development of an Indigenous Steering Committee that will examine our programs to make sure that they address community concerns and problems that we perceive communities to have.

The most difficult aspect of my year as Indigenous health coordinator was being confronted with my ignorance of Indigenous culture and the realisation that this could not be solved by reading textbooks or lectures alone but only through experience of Aboriginal Australia. However this year has given me some great experiences and a foundation upon which to build my professional and personal development. I have learnt a lot about patience, communication and I feel more comfortable when being faced with seemingly impossible challenges.

We attended two superb Indigenous festivals this year. The first was the Dreaming Festival that showcased the greatest music, dance and theatre that Indigenous Australia has to offer. We provided 16 subsidized season camping passes for students, unfortunately some went unfilled 21

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STUDENT ELECTIVES MICHAEL HURLEY, MBBS IV. Gove District Hospital, Northern Territory.

For my first elective in 2009 I was given the opportunity to attend Gove Hospital, Northern Territory. Having never set foot in the NT, I thought it would be a perfect time to check out the ‘Top End’ and combine it with some clinical experience. With a keen interest in rural and indigenous health I was eager to develop some necessary skills as a medical student.

Gove is situated on the Eastern side of the NT in ‘Arnhem Land’ along the coast. It is a mining town that primarily produces bauxite (for aluminium) and houses a population of over 4000 (60% Aboriginal).

My clinical experience was varied and interesting. Upon arrival I was greeted by the hospital team and was sent straight in to see patients in the Emergency Department. This was the predominant station-post for the medical students visiting Gove. I was given the opportunity to evaluate most patients, gather a history and physical examination, order investigations and carry out minor procedures with as little or as much supervision as I thought necessary. Although daunting at first, over the course of the elective I was able to develop a multitude of skills that will be able to be utilised during my career as a rural doctor. This aspect is the one that gave me the most enjoyment. I was finally able to use my textbook learning and hospital experience over the years to really apply my knowledge.

Despite feeling reasonably confident with many conditions seen in the metropolitan Emergency Department, little could prepare me for some of the cases I saw in the Indigenous population in Gove. Chronic disease truly is rampant and the carnage is evident daily in the hospital. Scabies, liver disease, rheumatic fever and otitis media 22

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were frequent conditions. Additionally, renal failure is practically common. Due to the lack of dialysis treatments available in Gove, many families are separated to seek treatment. This leads to problems within the community as many of the Aboriginal elders have to leave for treatment when their culture heavily relies on their input to assist the younger generations. Alcoholism in Gove was difficult to control. As Gove serviced many of the miners and their families, it was not a ‘dry’ community and therefore it housed many alcoholics. However, after speaking to many of the indigenous population both in town and in the hospital, it is evident that an awareness of the detriment of alcohol has begun to diffuse throughout the communities.

The team of doctors at Gove hospital comprised of one permanent doctor and locums who were generally completing their training programs.

All of these doctors were happy to sit down and teach different aspects of their speciality and how it pertained to rural health. I was given the opportunity to assist with many surgical procedures including general surgery, orthopaedics and obstetrics and gynaecology.

Many of these cases involved situations when organising transport to Darwin would take too long or was unavailable.

I was given the opportunity to fly into a small town (population of 800) called Raminginging, between Darwin and Gove. This town was a ‘dry’ Aboriginal community and it was vastly different to Gove. The town comprised of one small shop, dirt roads, stray hungry dogs, abandoned vehicles and a small medical clinic. This medical centre was similar to a GP clinic however it was focussed on preventative health and opportunistic medicine. I was given my own room and was able to perform some minor tasks. One of the days at Raminginging involved travelling to some of the outstations within 40km of town. We would travel with a doctor and a nurse and take bloods, collect urine and do a quick physical exam on the patients with chronic disease who were unable to attend clinic. At one of these visits, we were approached by a young aboriginal man who informed us his grandmother was unwell. One glance at this elderly lady was enough to know she was quite unwell, and was soon found to have urosepsis (with many chronic diseases).

The family claimed that she was an ‘old lady’

and therefore travelling to Darwin or even Gove for treatment was inappropriate and she was to stay in town. This was quite confronting, however I was informed that this often happened in these outstations with the elderly population. There is a strong sense of family in these areas and removing the elderly in these times is often unsuitable.

During our days off in Gove, Claire (Griffith) and Dave (UQ) and I would travel to many of the different communities and attractions in Arnhem Land. Many of the doctors and nurses provided us with mud-maps, crab pots, mountain bikes, fishing gear, 4WD equipment and a sense of adventure. We camped along river beds, hired boats for deep sea fishing (although only managed to catch tiny fish and coral) and drank beer. As Gove is such a small town, there were always events on every weekend – including a day of constructing a boat in a few hours from scrap wood and race around a buoy, a volleyball competition (involving every person in the town!), AFL games and Friday afternoon drinks at the surf club. It is a great town with a very close community. We were the odd ones out initially, but being part of the medical team did allow us to be invited to many local events and experience their real way of life in outback NT.

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PROFILE DR BILL GLASSON Biography: Dr William Glasson graduated from the University of Queensland in 1980 and completed his residency at the Princess Alexandra Hospital and the Mater Hospital. After completing his ophthalmic training in Brisbane he undertook postgraduate training in London in the area of ocular oncology as well as working in the area of lid and lacrimal pathology.

Dr Glasson also conducts clinics at Longreach, Winton, Barcaldine and Blackall. He is a past President of the Australian Medical Association and a consultant ophthalmologist to the Australian Army holding the rank of Lieutenant Colonel. He provides outreach services to the Australian indigenous population as well as providing ophthalmic services in East Timor.

What was the inspiration behind the career path that you chose?

I was born in Western Queensland on a rural property.

I grew up in a situation where we had lots of people working for us, both indigenous and non-indigenous.

We had a lot of indigenous stockman and shearers so I suppose I had a decent exposure to Indigenous culture.

I grew up with a fairly broad exposure of people from different backgrounds, personalities and expectations. A lot of people who worked there could best be described as alcoholics, but they were some of the nicest alcoholics you’d ever meet. As far as when they were sober they were great workers, very loyal and very committed.

Certainly from my mother’s perspective they were just fantastic to have around.

I did correspondence school for the first 7 years and my mother taught us for a couple of years followed by a governess. And that was on a property about 80 miles from town. So our life was on the property, doing things as the other workers did including mustering and shearing. I went to boarding school in Grade 8 and came home on the holidays. We still worked the property in between being at school. We went into periods of great drought where things were tough financially. My family struggled and most holidays I spent trying to feed and water drought stricken cattle. But although it was a tough upbringing, it was a great upbringing. It taught me a lot about life, and a lot about people. And I suppose it taught me to care about people. And to judge people on not what they have but who they are.

I then made the decision to do optometry. I was only 16

when I finished school and it was only a 3 year course.

And I had been exposed to optometrists coming out to Western Queensland as I had needed glasses. Having started optometry I immediately realised I wanted to do Ophthalmology. So I went into Medicine with a clear sight that I was heading for Ophthalmology.

I trained in Brisbane and went overseas for a couple of years and worked in London. When I came back I was approached to come onto the Trachoma and Eye Health program. That was an outpost of the Fred Hollows program. We set about to continue to provide services to Indigenous communities across Queensland, NSW and subsequently up in the Northern Territory. I sat on the Trachoma and Eye Health Board for many years and I suppose I had the intent of trying to grow a commitment amongst Ophthalmologists to rural and regional Australia. Subsequently when I became the chairman of the Royal College of Ophthalmologists in Queensland, I really set about to get as many people to go out as possible and provide services in rural and regional Australia. I wanted these Ophthalmologists to take ownership of those communities such that when they came back to major capital cities and to major practices, they still had a commitment to the patient’s out there.

This program I believe has worked very well. In Queensland we have something like 23 Ophthalmologists providing services to regional and rural Australia. And importantly when they do come back to their base practices they are still liaising with the Aboriginal Health workers and the doctor’s out there.

I have also seen much of the state of Indigenous health, housing and education. These are the elements of what we consider a basic standard of life and they have been absolutely destroyed. Destroyed in the sense that they have lost their cultural norms with alcohol being an absolute curse. So I had a passion for trying to make sure that we change this. Ultimately this passion drew me to become a part of the Northern Territory Taskforce.

And again I thought that was a great opportunity to get out there and say, listen we can’t fix health on it’s own because the paradigm of health is so much related to issues around education and housing, safety and security, clean water and hygiene. So it’s a complex solution to health because you can’t do it in isolation.

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WE OF THE MEDICAL PROFESSION HAVE A TREMENDOUS OPPORTUNITY TO CONTINUE TO LOBBY GOVERNMENTS AND ORGANIZATIONS TO SAY THAT THE CURRENT SITUATIONS ARE UNACCEPTABLE.

I felt that the NT intervention was the means to which you could put all these elements under one roof, and address them such that we could make a difference to health by having proper housing, clean water and by making sure that kids went to school. I have always said that education, education and education is the solution to most problems in society. I also thought that we needed to take control of alcohol as well as illegal drugs and petrol sniffing. We received a lot of criticism but in making these communities dry, it made them safer.

The other part of the strategy that received a lot of criticism was income management where we took the money that was received in pension payments to families and quarantined 50% of it such that it could only be spent on food, clothing and the basic elements of human life. Though it received initial criticism, it is probably one of the most successful parts of the intervention. The women loved it because they didn’t have men beating the door down in the morning to take what little bit of money they had, because the money was in the bank and they could only access it with a special card.

It meant that trolleys were full of food and the tummies of the children were full of food. It meant that the basic commodities that you and I take for granted were now available.

Part of the revamp included an overhaul of the grocery stores with proper quality food at the proper price. And Roger Corbett who was part of the Intervention went about doing that.

Those stores have turned a corner with regard to what types of food they offer and more importantly people can now afford to buy the food within them. The policing was important to maintain security, but that has become 24

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less of an issue as you move the alcohol out of the equation.

With regard to education, there are currently 2000 students not even registered to go to school and 2000 registered that don’t go to school. We must ensure that children go to school. There is no argument about it.

Schooling is learning about the basic elements of life. And part of the education is also for the parents, because the parents have not had the sort of education that you and I have taken for granted. So in many cases the mothers go to school with the children. These mothers have often not been taught how to cook, or why it is important to clean your teeth. So it is all those basic elements that you and I take for granted that need to be reinforced.

My passions also take me up to Timor where we do a lot of work. Again it is a very underprivileged group of people. The Timorese are a wonderful people who can live on a dollar a day. They don’t have an alcohol problem and they are not given money as a hand out. To restore vision within these communities, and to make a difference in the lives of individual in these communities is a privilege.

What sort of legacy do you want to leave?

I don’t want to sit on my rocking chair and see that the state of Indigneous health has remained the same 20 or 30 years after the intervention. We have to make a difference here. I would like to be recognised as one of many people who have tried to make a difference to the lives of our Indigenous people.

I also would like to try and make sure that we have provided a future for our Indigenous children and to have developed a system where

indigenous children can develop the selfidentity and self-confidence that you and I take for granted. If you wake up in the morning and you don’t feel good about yourself, and you don’t feel confident or believe in yourself how can you take up a mainstream job, or compete with the non-Indigenous sector.

So I want Indigenous kids to be proud of being Indigenous, proud of the fact that they have had a good education and proud that they have been given the same opportunities as nonIndigenous children.

What advice would you give medical students/ junior doctors.

We of the medical profession have a tremendous opportunity to continue to lobby Governments and organizations to say that the current situations are unacceptable. We also have the ability to give them some guidance as to how we can turn this around. Obviously we need some support in the sense of doctors, nurses and allied health professionals who are willing to go out directly to communities and provide services. And I would ask that you all to do that. But also get involved in the debate as to how we should all do this in the long term.

I think we are in a very privileged profession and a privileged position to make a difference and to contribute directly and indirectly with regard to how funding and policy should be rolled out and changed.

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ARTICLE DR MICHAEL RICE Biography: Dr Michael Rice is a General Practitioner in Beaudesert, Queensland. He is currently on the management committee of the Rural Doctor’s Association of Queensland. Reflections on living and working in country medicine. I never expected to find myself working in general practice, much less, in general practice in the “country”. But sometimes one thing leads to another, doors open, and the unexpected comes to pass.

I never thought there would be people in South East Queensland who travelled for an hour to get to the doctor, or who only came into “town” once every couple of weeks. Born and bred and trained in the city, I knew not a thing about cattle, or fencing, rutted driveways, tankwater, dams or B&S balls. Nor, for that matter, much about dying at home, house-calls, skin cancer or patients whose diagnoses were more elusive than any single chapter, lecture or hospital ward could explain. I didn’t know about changing “hats” between the surgery, the kindy barbeque, the shops and the service clubs. I thought general practice was about coughs and colds. I know a lot more, now.

I found myself doing a general practice rotation in Beaudesert in my second postgraduate year. Then, it was the Family Medicine Program and a common rotation for junior doctors; now it might be the PGPPP. I had been allocated the rotation at short notice, few placings were available and the urban offering was unappealing as I had

been on the receiving end of poor quality referrals from that particular practice in my Casualty days. So I opted to commute into the “country”. I didn’t travel a very long way, just about an hour, but found another, unexpected, world. And I really enjoyed it. What was it I liked about working in Beaudesert? No bullshit, for a start. Apart from occasional bits of the real stuff left behind on the couch or consulting room floor! I met patients who told me what they thought: honest, straightforward, to the point. Their trust and respect had to be earned and I worked with doctors who had done just that. Doctors who treated their illnesses, healed their wounds, delivered their babies and cared for their grandparents.

A medical school colleague, asked by a specialist what he wanted to do in medicine, had said “everything” and was told “That’s not sane.” He settled for psychiatry (the only doctors who take a proper history?). But in a country town within commuting distance of home I found something quite close.In general practice, anywhere, you could (in theory), do almost everything.

OK, no neurosurgery or joint replacements or any of that super-high-tech tertiary stuff; but beyond coughs and colds there are illnesses and injuries, pregnancies and palliative care, diagnostic dilemmas and situational stresses that we can and do learn to manage. Here, I found that patients and doctors alike actually expected to “do it all.” A “can-do” attitude is surprisingly affirming, especially when you discover it’s not unrealistic.

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RURAL

A “CAN-DO” ATTITUDE IS SURPRISINGLY AFFIRMING, ESPECIALLY WHEN YOU DISCOVER IT’S NOT UNREALISTIC.

So after that first rotation, I returned, and returned again after a year as a PHO in adult internal medicine, and with my wife’s support and an infant in tow we made the move. When you actually start living in a rural community, there are more interesting things than just the work.

It’s not unusual, for example, for doctors to venture into agriculture and so we invested in two cows: Miss T(-bone) and Barbie(Q), Misty and Barbie for short. Barbie went missing the first day and turned out to be something of a troublemaker, visiting 3 local dairies (and leaping out of full-sized yards) before she was found and went back to Boyd’s yards to be “settled down”. Did I mention Boyd’s yards were at his abattoir?

There was “a bit of a mistake” and we got our money back on Barbie. Miss T’s career was longer, but eventually she, too, became more trouble than she was worth and ownership passed to a neighbour. Now, we settle for chooks.

Work takes another dimension when you’re living locally and I soon found myself wearing another hat as “visiting obstetrician” in Queensland’s busiest non-specialty birthing unit, courtesy of the Diploma I had picked up in my third postgrad year. General practice work has the potential to be a bit solitary, even in a group practice, but hospital work brings the pleasures of working with a great team. Obstetric work, in particular, requires a collaborative approach and it was a great shame after a decade to watch all of that unravel and join the monthly roll-call of Australian rural maternity units that closed their doors in the 1990’s and 2000’s.

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It has been an even greater shame to watch the contraction of other hospital services that followed, as they inevitably do when birthing services close, and more and more locals have to travel for those low-tech “everything” services that country hospitals and doctors can provide. The erosion of the “can-do” attitude can be quite depressing.

But challenges bring opportunities. Out of the decline in local services, and parallel crises elsewhere in Queensland that spawned several inquiries, I discovered the power of representative organisations, and of the media. I became increasingly involved with the Rural Doctors Association of Queensland, and through that body, became connected with newspapers, radio and television, with local, state and federal government, Queensland Health, workforce agencies, other rural doctors, and, interestingly, with students’ rural health clubs like HOPE4HEALTH and TROHPIQ about which I’d known little.

And from what could have been a depressing time, I’ve become increasingly optimistic for a bright future for country doctors and their communities. For I’ve learned that just as agriculture survives drought, that country medical practice will survive the shortages and cutbacks of the last decade or so.

Sound leadership, meaningful reform of public policy and working conditions, an energetic existing profession and the enthusiasm of the next wave of graduates means that we really “can-do” and will have a lot of fun doing it.

d

RURAL

RURAL EXPERIENCES JORDAN WHICKER Jordan is a second year medical student and was rural health officer in 2009. He is from Caboolture and is looking forward to pursuing a career in rural health.

During 2009 HOPE4HEALTH was able to run a number of rural trips. The first trip of the year started with the Joint Rural Health Club Weekend to Beaudesert in April.

The trip involved twenty students from each of the four Queensland Rural Health Clubs (TROHPIQ, BUSHFIRE, RHINO, and HOPE4HEALTH) coming together to focus on rural health. The weekend involved various presentations and skills sessions pertaining to rural healthcare in Queensland and also allowed for many strong ties to form between students. The trip requires a lot of organising and a working party from each of the RHCs and Health Workforce Queensland was formed to organise this.

H4H also has a strong affiliation with the National Rural Health Students Network (NRHSN). Members attended both FACE2FACE meetings in Melbourne in March and September, and also attended the National University Rural Health Conference in July in Cairns. At this conference students heard from political leaders at the forefront of Australian rural health and also participated in a number of sessions aimed at strengthening student roles in rural health. The conference was a huge success and H4H even managed to pick up the coveted silver medal in the Golden Windmills presentation night. Next year with a bit of luck and a few mankinis we may be able to pick up the gold.

During the year, H4H also completed two Rural High School Visits, one to Kingaroy and one to Roma. These trips involved four students driving out to these rural locations and visiting each of the high schools. The students presented a brief presentation and completed some fun workshops with the students. The aim of these trips is to increase the interest of healthcare careers in these students. These trips were very rewarding to both the presenters and the high school students. The trips allowed students to appreciate the challenges faced by people living in rural Queensland.

In June twelve members of H4H were able to attend the Rural Doctors’ Association of Queensland Conference on the Gold Coast. Again this event gave students the chance to interact with many of the leaders in rural

medicine in Queensland and build up some strong ties with other rurally focused students from the RHCs. A honourable mention must go to H4Hs Barry Jackson who presented a paper at this conference.

Our last trip for the year was a trip to Bundaberg. Twelve students attended Bundaberg Base Hospital for a weekend to listen to some presentations and participate in some interesting skills stations. This trip was thoroughly enjoyed by all and we are looking to make the Bundaberg trip an annual event. A big thankyou must also go to Dr Gabrielle du-Preez Wilkinson who helped make this trip possible.

Many people provided assistance to me this year in running the rural portfolio. Fran Riley from Health Workforce Queensland helped to organise the JRHCW, RHSVs, RDAQ and also provided advertising to the other RHCs about the Midnight Muster. H4H is greatly appreciative of the help given to us by HWQ and hopes to continue this strong relationship into the future. Many other people helped make this year great for the rural portfolio and I thank them all for it.

It was an honour being the Rural Health Coordinator of HOPE4HEALTH during 2009. Over the past two years I have been fortunate enough to attend all but a few of the rural trips that H4H has run. This has given me a greater appreciation for rural medicine and health care in general. Liaising with many of the great personalities of rural health in Queensland has given me an increased drive to work rurally upon completion of studies. I wish next year’s coordinator, Brodie Quinn, the best of success with the portfolio.

LIAISING WITH MANY OF THE GREAT PERSONALITIES OF RURAL HEALTH IN QUEENSLAND HAS GIVEN ME AN INCREASED DRIVE TO WORK RURALLY UPON COMPLETION OF STUDIES.

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ABOUT US

ABOUT US HOPE4HEALTH HOPE4HEALTH IS A NON-PROFIT ORGANISATION AND REGISTERED CHARITY THAT WAS FOUNDED BY GRIFFITH UNIVERSITY STUDENTS IN 2006.

HOPE4HEALTH aims to improve health outcomes for local, rural, indigenous and international communities.

MANAGEMENT TEAM IN 2009

We achieve our goals by coordinating awareness raising activities for our members including guest speaker seminars, rural health trips, teddy bear hospitals and much more.

Each year we host two major corporate fundraising events in support of our projects.

These events are called the H4H Jazz Dinner Dance and the H4H Professionals Cup Golf Day. Past projects that we have supported include the Dabaa Medical Centre in Ghana and the Royal Flying Doctor’s Service (Queensland).

Over the past 4 years over $150,000 has been raised for projects around the world.

Currently the club has around 600 members.

HOPE4HEALTH is a member of the National Rural Health Students Network and the Global Health Network.

President: Vice President: Treasurer: Secretary: Local Health Coordinator: Rural Health Coordinator: Indigenous Health Coordinator: International Health Coordinator: NRHSN Representative: GHN Representative: Psychology Representative: Physiotherapy and Exercise Science Representative: Dentistry Representative: Nursing and Midwifery Representative: Chief Executive Officer: Director of Sponsorship: Director of Alumni: Director of Corporate Events:

HOPE4HEALTH won the award for ‘Cultural Club of the Year’ at Griffith University in 2008 and again in 2009.

Director of Public Relations: Director of Communications: Director of Art Galleries:

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Warwick Isaacson (MBBS II) Alix Longbottom (MBBS II) Jill Parkes-Smith (MBBS II) Adrian Castelli (MBBS II) Lucy Francis (MBBS II) Jordan Whicker (MBBS II) Walter Hipgrave (MBBS II) Louise Van Camp (MBBS II) Lucy Barnett (MBBS IV) Bradley Plettell (MBBS II) Rebecca Dale Kyle Maloney Sally Fairbairn Rachel Dickson Luke Eggleston (MBBS III) Marty Brewster (MBBS IV) Linda Dalic (MBBS IV) Sally Moore (MBBS III), Julia Kent (MBBS III), Aaron Griffin (MBBS II) Claire Cuscaden (MBBS IV) Travis Auty (MBBS II) Brett Drury (MBBS IV)

For professional corporate design, to printing & websites, we are your total visual solution.

www.csquared.com.au Email info@csquared.com.au Phone (07) 5564 6847 29

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HOPE4HEALTH Inc PO Box 1545 Southport Business Centre SOUTHPORT QLD 4215 (M) 0434 171 656 (E) info@hope4health.org.au

www.hope4health.org.au

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